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Luo Y, Mai L, Liu X, Yang C. Effectiveness of continuous home wound care on patients with diabetic foot ulcers. J Adv Nurs 2024; 80:3395-3413. [PMID: 38156736 DOI: 10.1111/jan.16039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
AIMS To explore the effectiveness of continuous home wound care on patients with diabetic foot ulcers (DFUs). DESIGN A non-randomized parallel controlled non-inferiority trial. METHODS Patients with Wagner grade I-III DFUs hospitalized in two distant campuses of the same hospital were included. All patients received infection treatment and wound bed preparation during hospitalization; after discharge, patients in one of the campuses received routine outpatient wound care, and those treated in the other received continuous home wound care. The per-protocol analysis was performed to compare ulcer healing indicators, knowledge, health belief, self-management behaviour and medical expenses of the two groups. RESULTS Between October 2021 and December 2022, 116 patients were enrolled in the study; 107 completed. The home care was not inferior in terms of ulcer healing rate and demonstrated significant enhancements in the understanding of warning signs, health belief and self-management behaviour. Additionally, the home care saved 220.38 yuan (24.32 UK pounds) in direct medical expenses for each additional one square centimetre of ulcer healing. CONCLUSION The continuous home wound care enhanced self-management behaviour of the patients and saved their medical expenses while not compromising ulcer healing. IMPACT This is to date the first study to conduct continuous home wound care practice for patients with DFUs and confirmed its safety and non-inferiority in ulcer healing, and supported its superiority in improving self-management behaviour and saving medical expenses. REPORTING METHOD We have adhered to the transparent reporting of evaluations with nonrandomized designs statements and the corresponding checklist was followed. PATIENT OR PUBLIC CONTRIBUTION The patients and their primary caregivers were involved in intervention design, we received input from them about the factors that facilitate and hinder patient self-management behaviours to develop intervention strategies.
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Affiliation(s)
- YiXin Luo
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - LiFang Mai
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - XingZhou Liu
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Slivnik M, Navodnik Preložnik M, Fir M, Jazbar J, Čebron Lipovec N, Locatelli I, Liette Lauzon H, Urbančič Rovan V. A randomized, placebo-controlled study of chitosan gel for the treatment of chronic diabetic foot ulcers (the CHITOWOUND study). BMJ Open Diabetes Res Care 2024; 12:e004195. [PMID: 38909998 DOI: 10.1136/bmjdrc-2024-004195] [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: 03/15/2024] [Accepted: 06/07/2024] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION To assess the efficacy of a chitosan-based gel (ChitoCare) for the treatment of non-healing diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS Forty-two patients with chronic DFUs were randomized to the ChitoCare or placebo gel for a 10-week treatment period and 4-week follow-up. The primary study end point was the rate of complete wound closure at week 10, presented as relative rate. RESULTS Thirty patients completed the 10-week treatment and 28 completed the 4-week follow-up. The ChitoCare arm achieved 16.7% complete wound closure at week 10 vs 4.2% in the placebo arm (p=0.297), 92.0% vs 37.0% median relative reduction in wound surface area from baseline at week 10 (p=0.008), and 4.62-fold higher likelihood of achieving 75% wound closure at week 10 (p=0.012). Based on the results of the Bates-Jensen Wound Assessment Tool, the wound state at week 10 and the relative improvement from the baseline were significantly better (median 20 vs 24 points, p=0.018, and median 29.8% vs 3.6%, p=0.010, respectively). CONCLUSIONS ChitoCare gel increased the rate of the DFU healing process. Several secondary end points significantly favored ChitoCare gel. TRIAL REGISTRATION NUMBER NCT04178525.
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Affiliation(s)
- Matevž Slivnik
- Vizera d.o.o, Ljubljana, Slovenia
- University of Ljubljana Faculty of Pharmacy, Ljubljana, Slovenia
| | | | | | - Janja Jazbar
- University of Ljubljana Faculty of Pharmacy, Ljubljana, Slovenia
| | | | - Igor Locatelli
- University of Ljubljana Faculty of Pharmacy, Ljubljana, Slovenia
| | | | - Vilma Urbančič Rovan
- University Medical Centre Ljubljana, Ljubljana, Slovenia
- University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
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Lingyan L, Liwei X, Han Z, Xin T, Bingyang H, Yuanyuan M, Peiwei Q, Peifen M. Identification, influencing factors and outcomes of time delays in the management pathway of diabetic foot: A systematic review. J Tissue Viability 2024; 33:345-354. [PMID: 38594149 DOI: 10.1016/j.jtv.2024.04.007] [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: 10/25/2023] [Revised: 01/23/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE A systematic review was conducted to evaluate the time delays in the management of diabetic foot and explore influencing factors of these delays and potential outcomes. METHODS The researchers searched several electronic databases (Pubmed, Web of Science, Cochrane Library, EMbase, CNKI, WanFang, CBM and VIP) for English and Chinese studies that examined time delays in the management pathway of diabetic foot. Two authors independently screened and extracted data, and assessed the quality of the included studies using the Newcastle-Ottawa Scale and the Agency for Health Research and Quality checklist. Due to heterogeneity among the studies, descriptive analysis was performed. RESULTS The review included 28 articles, comprising 20 cohort studies and 8 cross-sectional studies, that met the inclusion criteria. Among these, 14 were deemed of high quality. The median times from symptom onset to primary health care or specialist care varied from 3 to 46.69 days. The median delay in referral by primary care specialists ranged from 7 to 31 days, and subsequent median times to definitive treatment ranged from 6.2 to 56 days. Multiple complex factors were found to contribute to these delays, including patient demographics (older age, lower education level and income level) and poor patient health-seeking behaviors (inaccurate self-treatment, incorrect recognition and interpretation of symptoms), inaccurate assessment or initial treatment by health primary professionals, complex referral pathways and clinical characteristics of diabetic foot (number of foot ulcers, Wagner grade scale, and hemoglobin A1c index). Negative outcomes associated with these delays included increased risk of major amputation and mortality, decreased wound healing rate, prolonged hospital stay, and increased hospital costs. CONCLUSIONS Time delays in the diabetic foot management pathway were both common and serious, contributing to negative health outcomes for patients with diabetic foot. Many complex factors related to patient's poor patient health-seeking behaviors, health system, and clinical characteristics of diabetic foot are responsible for these delays. Therefore, it is necessary to develop new strategies for standard referral practices and strengthen patient awareness of seeking care.
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Affiliation(s)
- Li Lingyan
- School of Nursing, Lanzhou University, No. 28 Yanxi Road, Lanzhou, 730000, Gansu Province, PR China
| | - Xu Liwei
- Department of Burns, The Second Hospital of Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, PR China
| | - Zhao Han
- School of Nursing, Lanzhou University, No. 28 Yanxi Road, Lanzhou, 730000, Gansu Province, PR China
| | - Tang Xin
- Department of Burns, The Second Hospital of Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, PR China
| | - He Bingyang
- School of Nursing, Lanzhou University, No. 28 Yanxi Road, Lanzhou, 730000, Gansu Province, PR China
| | - Ma Yuanyuan
- School of Nursing, Lanzhou University, No. 28 Yanxi Road, Lanzhou, 730000, Gansu Province, PR China
| | - Qin Peiwei
- School of Nursing, Lanzhou University, No. 28 Yanxi Road, Lanzhou, 730000, Gansu Province, PR China
| | - Ma Peifen
- School of Nursing, Lanzhou University, No. 28 Yanxi Road, Lanzhou, 730000, Gansu Province, PR China; Department of Nursing, The Second Hospital of Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, PR China.
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Yazdanpanah L, Shahbazian H, Hesam S, Ahmadi B, Zamani AM. Two-year incidence and risk factors of diabetic foot ulcer: second phase report of Ahvaz diabetic foot cohort (ADFC) study. BMC Endocr Disord 2024; 24:46. [PMID: 38622562 PMCID: PMC11017491 DOI: 10.1186/s12902-024-01572-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
AIM/INTRODUCTION This study was designed as the second phase of a prospective cohort study to evaluate the incidence and risk factors of diabetic foot ulcers (DFU). MATERIALS AND METHODS The study was conducted in a university hospital in Iran. Each participant was checked and followed up for two years in terms of developing newfound DFU as ultimate outcome. We investigated the variables using univariate analysis and then by backward elimination multiple logistic regression. RESULTS We followed up 901 eligible patients with diabetes for two years. The mean age of the participants was 53.24 ± 11.46 years, and 58.53% of them were female. The two-year cumulative incidence of diabetic foot ulcer was 8% (95% CI 0.071, 0.089) [Incidence rate: 49.9 /1000 person-years]. However, the second-year incidence which was coincident with the COVID-19 pandemic was higher than the first-year incidence (4.18% and 1.8%, respectively). Based on our analysis, the following variables were the main risk factors for DFU incidence: former history of DFU or amputation [OR = 76.5, 95% CI(33.45,174.97), P value < 0.001], ill-fitting foot-wear [OR = 10.38, 95% CI(4.47,24.12), P value < 0.001], smoking [OR = 3.87,95%CI(1.28, 11.71),P value = 0.016], lack of preventive foot care [OR = 2.91%CI(1.02,8.29),P value = 0.045], and insufficient physical activity[OR = 2.25,95% CI(0.95,5.35),P value = 0.066]. CONCLUSION Overall, the two-year cumulative incidence of diabetic foot ulcer was 8% [Incidence rate: 49.9 /1000 person-years]; however, the second-year incidence was higher than the first-year incidence which was coincident with the COVID-19 pandemic (4.18% and 1.8%, respectively). Independent risk factors of DFU occurrence were prior history of DFU or amputation, ill-fitting footwear, smoking, lack of preventive foot care, and insufficient physical activity.
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Affiliation(s)
- Leila Yazdanpanah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran.
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran
| | - Saeed Hesam
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Ahmadi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Mohammad Zamani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Monteiro-Soares M, Hamilton EJ, Russell DA, Srisawasdi G, Boyko EJ, Mills JL, Jeffcoate W, Game F. Guidelines on the classification of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev 2024; 40:e3648. [PMID: 37179483 DOI: 10.1002/dmrr.3648] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND This publication represents a scheduled update of the 2019 guidelines of the International Working Group of the Diabetic Foot (IWGDF) addressing the use of systems to classify foot ulcers in people with diabetes in routine clinical practice. The guidelines are based on a systematic review of the available literature that identified 28 classifications addressed in 149 articles and, subsequently, expert opinion using the GRADE methodology. METHODS First, we have developed a list of classification systems considered as being potentially adequate for use in a clinical setting, through the summary of judgements for diagnostic tests, focussing on the usability, accuracy and reliability of each system to predict ulcer-related complications as well as use of resources. Second, we have determined, following group debate and consensus, which of them should be used in specific clinical scenarios. Following this process, in a person with diabetes and a foot ulcer we recommend: (a) for communication among healthcare professionals: to use the SINBAD (Site, Ischaemia, Bacterial infection, Area and Depth) system (first option) or consider using WIfI (Wound, Ischaemia, foot Infection) system (alternative option, when the required equipment and level of expertise is available and it is considered feasible) and in each case the individual variables that compose the systems should be described rather than a total score; (b) for predicting the outcome of an ulcer in a specific individual: no existing system could be recommended; (c) for characterising a person with an infected ulcer: the use of the IDSA/IWGDF classification (first option) or consider using the WIfI system (alternative option, when the required equipment and level of expertise is available and it is considered as feasible); (d) for characterising a person with peripheral artery disease: consider using the WIfI system as a means to stratify healing likelihood and amputation risk; (e) for the audit of outcome(s) of populations: the use of the SINBAD score. CONCLUSIONS For all recommendations made using GRADE, the certainty of evidence was judged, at best, as being low. Nevertheless, based on the rational application of current data this approach allowed the proposal of recommendations, which are likely to have clinical utility.
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Affiliation(s)
- Matilde Monteiro-Soares
- Portuguese Red Cross School of Health-Lisbon, Lisbon, Portugal
- MEDCIDS-Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine of the University of Porto, Porto, Portugal
- RISE@ CINTESIS, Faculty of Medicine Oporto University, Porto, Portugal
| | - Emma J Hamilton
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Murdoch, Australia
- University of Western Australia, Medical School, Fiona Stanley Hospital, Murdoch, Australia
| | - David A Russell
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gulapar Srisawasdi
- Department of Rehabilitation Medicine, Sirindhorn School of Prosthetics Orthotics, Bangkok, Thailand
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Edward J Boyko
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Joseph L Mills
- Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Houston, Texas, USA
| | | | - Frances Game
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Monteiro-Soares M, Hamilton EJ, Russell DA, Srisawasdi G, Boyko EJ, Mills JL, Jeffcoate W, Game F. Classification of foot ulcers in people with diabetes: A systematic review. Diabetes Metab Res Rev 2024; 40:e3645. [PMID: 37132179 DOI: 10.1002/dmrr.3645] [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: 04/09/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Classification and scoring systems can help both clinical management and audit the outcomes of routine care. AIM This study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot. METHODS We searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer. RESULTS We found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt-Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer-free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost. CONCLUSION Despite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios.
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Affiliation(s)
- Matilde Monteiro-Soares
- Portuguese Red Cross School of Health - Lisbon, Lisbon, Portugal
- MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine of the University of Porto, Porto, Portugal
- RISE@CINTESIS, Faculty of Medicine Oporto University, Porto, Portugal
| | - Emma J Hamilton
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- University of Western Australia, Medical School, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David A Russell
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gulapar Srisawasdi
- Department of Rehabilitation Medicine, Sirindhorn School of Prosthetics Orthotics, Bangkok, Thailand
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Edward J Boyko
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Joseph L Mills
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Fran Game
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Widigdo DAM, Sofro ZM, Pangastuti HS, Dachlan I. The Efficacy of Negative Pressure Wound Therapy (NPWT) on Healing of Diabetic Foot Ulcers: A Literature Review. Curr Diabetes Rev 2024; 20:1-11. [PMID: 37921159 DOI: 10.2174/0115733998229877230926073555] [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: 11/04/2022] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Diabetes mellitus is a complex disorder that requires continuous management to control blood sugar levels and prevent complications. Diabetic foot ulcers (DFU) are the most common complication in diabetic patients. A popular therapy modality with considerable advantages in the management of diabetic foot ulcers today is negative pressure wound therapy (NPWT). OBJECTIVE This study aimed to review related articles about the efficacy as well as the complications or adverse effects of using NPWT on the healing of DFUs. METHODS Searching English databases from PubMed, Ebscohost, Proquest and Science Direct was done to identify relevant citations published between January 2017 and January 2022. A combination of terms was used with the boolean formulation of "negative pressure wound therapy OR NPWT" OR "vacuum-assisted closure or VAC" AND "diabetic foot ulcers OR diabetic foot wound" AND "wound healing" AND "Conventional dressings" and map terms were also used for the subject heading. Some potentially relevant citations of articles from the bibliographies are also reviewed. RESULTS This study included 8 related articles consisting of 6 RCTs, 1 cohort study and 1 Quasy experimental study. There were various methodological techniques for using NPWT and outcome measures among studies. The results of this literature review showed that NPWT was more efficacious than the other conventional or advanced moist dressings. This therapy revealed a faster healing time with complete wound healing and formation of granulation tissue and reduction in wound size. The complications or adverse effects of NPWT, such as amputation rate, bleeding and pain, were not different from conventional or advanced moist dressings, though. CONCLUSION NPWT was more efficacious than other conventional or advanced moist dressings for the healing of DFUs. However, complications or adverse effects of using this therapy showed no significant difference with other conventional or advanced moist dressings.
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Affiliation(s)
| | - Zaenal Muttaqien Sofro
- Department of Physiology, The Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Heny Suseani Pangastuti
- Department of Medical Surgical Nursing, The Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ishandono Dachlan
- Department of Plastic, Reconstructive and Aesthetic Surgery, The Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Xu H, Wu C, Xiang S, Qiu S, Chen Y, Takashi E, Yanagihara K, Xie P. Psychosocial markers of pre-hospital delay in patients with diabetic foot: A cross-sectional survey. Nurs Open 2024; 11:e2088. [PMID: 38268288 PMCID: PMC10803947 DOI: 10.1002/nop2.2088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
AIM This study aimed to determine the psychosocial markers associated with pre-hospital delay among patients with diabetic foot (DF). DESIGN This study has a cross-sectional design. METHODS The participants completed a questionnaire including pre-hospital time, demographic characteristics, Social Support Rate Scale, Brief Illness Perception Questionnaire and Type D Personality Scale-14. Bivariate and multivariate analyses were conducted to explore independent associations with pre-hospital delay. RESULTS Only 1.8% (3/164) of participants arrived at the hospital for medical care in 24 h of symptom onset. Patients with low utilization of social support (p = 0.029), low negative illness perceptions (p = 0.014) and high levels of negative affectivity (p = 0.009) are likely to arrive late at the clinic. Medical staff should pay attention to identifying diabetic patients' Type D personalities and take actions to improve their social support as well as illness perception, so as to reduce the occurrence of hospital delay. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Psychosocial factors play a vital role in the delay in seeking medical treatment for patients with DF. Medical staff need to improve patients' illness perception as well as self-management ability through health education. Importantly, key family members provide an emotional and psychological support system for diabetic patients. Therefore, nurses need to work with family members together to give information and psychological support during family visits. Additionally, building and maintaining trust with patients is crucial to encouraging individuals to express their concerns and worries. In this case, nurses may identify patients' negative emotions and conduct timely intervention, so as to achieve favourable outcomes. PATIENT OR PUBLIC CONTRIBUTION This study used a convenience sample of 164 participants with DF recruited from the wound clinic of Northern Jiangsu People's Hospital and Yangzhou Hospital of TCM in China.
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Affiliation(s)
- Huiwen Xu
- School of Nursing & Public HealthYangzhou UniversityYangzhouJiangsuChina
- Nagano College of NursingKomaganeNaganoJapan
| | - Chen Wu
- School of Nursing & Public HealthYangzhou UniversityYangzhouJiangsuChina
| | | | - Shuang Qiu
- Yangzhou Hospital of Traditional Chinese MedicineYangzhouJiangsuChina
| | - Yan Chen
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University/Clinical Medical CollegeYangzhou UniversityYangzhouJiangsuChina
| | - En Takashi
- Nagano College of NursingKomaganeNaganoJapan
| | | | - Ping Xie
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University/Clinical Medical CollegeYangzhou UniversityYangzhouJiangsuChina
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Pereira MG, Vilaça M, Braga D, Madureira A, Da Silva J, Santos D, Carvalho E. Healing profiles in patients with a chronic diabetic foot ulcer: An exploratory study with machine learning. Wound Repair Regen 2023; 31:793-803. [PMID: 38073283 DOI: 10.1111/wrr.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 12/26/2023]
Abstract
Diabetic foot ulcers (DFU) are one of the most frequent and debilitating complications of diabetes. DFU wound healing is a highly complex process, resulting in significant medical, economic and social challenges. Therefore, early identification of patients with a high-risk profile would be important to adequate treatment and more successful health outcomes. This study explores risk assessment profiles for DFU healing and healing prognosis, using machine learning predictive approaches and decision tree algorithms. Patients were evaluated at baseline (T0; N = 158) and 2 months later (T1; N = 108) on sociodemographic, clinical, biochemical and psychological variables. The performance evaluation of the models comprised F1-score, accuracy, precision and recall. Only profiles with F1-score >0.7 were selected for analysis. According to the two profiles generated for DFU healing, the most important predictive factors were illness representations on T1 IPQ-B (IPQ-B ≤ 9.5 and < 10.5) and the DFU duration (≤ 13 weeks). The two predictive models for DFU healing prognosis suggest that biochemical factors are the best predictors of a favorable healing prognosis, namely IL-6, microRNA-146a-5p and PECAM-1 at T0 and angiopoietin-2 at T1. Illness perception at T0 (IPQ-B ≤ 39.5) also emerged as a relevant predictor for healing prognosis. The results emphasize the importance of DFU duration, illness perception and biochemical markers as predictors of healing in chronic DFUs. Future research is needed to confirm and test the obtained predictive models.
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Affiliation(s)
- M Graça Pereira
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Margarida Vilaça
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Diogo Braga
- Interdisciplinary Studies Research Center (ISRC), ISEP, Porto, Portugal
| | - Ana Madureira
- Interdisciplinary Studies Research Center (ISRC), ISEP, Porto, Portugal
- ISEP, Polytechnic of Porto, Porto, Portugal
- Institute for Systems and Computer Engineering, Technology and Science (INOV), Lisboa, Portugal
| | - Jéssica Da Silva
- PhD Program in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research, Coimbra, Portugal
- Center for Neuroscience and Cell Biology (CNC), Center for Innovative Biotechnology and Biomedicine (CIBB), University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
| | - Diana Santos
- PhD Program in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research, Coimbra, Portugal
- Center for Neuroscience and Cell Biology (CNC), Center for Innovative Biotechnology and Biomedicine (CIBB), University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
| | - Eugénia Carvalho
- Center for Neuroscience and Cell Biology (CNC), Center for Innovative Biotechnology and Biomedicine (CIBB), University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
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Luo Y, Mai L, Liu X, Yang C. Effectiveness of continuous home wound care on wound healing, self-management behavior, and medical expenses of patients with diabetic foot ulcers. J Tissue Viability 2023:S0965-206X(23)00107-9. [PMID: 37884436 DOI: 10.1016/j.jtv.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/03/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To explore the effectiveness of continuous home wound care on wound healing, self-management behavior, and medical expenses of patients with diabetic foot ulcers. MATERIALS AND METHODS Patients were grouped by the campuses they were hospitalized. One group received home wound care, and the other one received outpatient wound care after their discharge. Non-inferiority testing was performed to compare ulcer healing. Their Diabetes-related Foot Ulcer Self-Management Behavior Scale (DFUSMBS) scores and medical expenses were compared. RESULTS Between October 2021 and December 2022, fifty-five patients in the home wound care group and fifty-two in the outpatient wound care group completed the study. The home wound care was non-inferior concerning ulcer complete healing rate in total or stratified by Wagner grade or baseline ulcer area. Concerning wound healing time, the home wound care group was inferior for Wagner Grade Ⅲ ulcers (hazard ratio = 0.7772, 95 % CI = 0.2799-2.1581). In contrast, for ulcers with baseline area>5 cm2, the home care group was non-inferior and even can be superior, although the superiority was not statistically significant (Log-rank X2 = 0.257, p = 0.612). Moreover, the home wound care group showed significant improvement concerning timely wound treatment (t = 23.045, p < 0.001, Cohen's d = 4.460, Effect Size = 0.912) and wound care behavior (t = 33.410, p < 0.001, Cohen's d = 6.454, Effect Size = 0.955), while that of diabetes self-management was not statistically significant (t = -0.673, p = 0.502, Cohen's d = 0.128, Effect Size = 0.064). The medium direct medical expense per capita of the patients in the outpatient care group was statistically significantly heavier than that of the home wound care group (Z = -6.877, p < 0.001). CONCLUSION The home wound care practice did not compromise ulcer healing, enhanced timely wound treatment and wound care behavior of the patients, and saved their medical expenses, hopefully providing a feasible wound care alternative with economic benefits for the physically and economically devastated patients.
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Affiliation(s)
- YiXin Luo
- School of Nursing, Sun Yat-sen University, Guangzhou, 510080, China
| | - LiFang Mai
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - XingZhou Liu
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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11
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Vossen LE, van Netten JJ, Bakker CD, Berendsen HA, Busch-Westbroek TE, Peters EJG, Sabelis LWE, Dijkgraaf MGW, Bus SA. An integrated personalized assistive devices approach to reduce the risk of foot ulcer recurrence in diabetes (DIASSIST): study protocol for a multicenter randomized controlled trial. Trials 2023; 24:663. [PMID: 37828618 PMCID: PMC10568814 DOI: 10.1186/s13063-023-07635-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Preventing foot ulcers in people with diabetes can increase quality of life and reduce costs. Despite the availability of various interventions to prevent foot ulcers, recurrence rates remain high. We hypothesize that a multimodal treatment approach incorporating various footwear, self-management, and education interventions that matches an individual person's needs can reduce the risk of ulcer recurrence with beneficial cost-utility. The aim of this study is to assess the effect on foot ulcer recurrence, footwear adherence, and cost-utility of an integrated personalized assistive devices approach in high-risk people with diabetes. METHODS In a parallel-group multicenter randomized controlled trial, 126 adult participants with diabetes mellitus type 1 or 2, loss of protective sensation based on the presence of peripheral neuropathy, a healed plantar foot ulcer in the preceding 4 years, and possession of any type of custom-made footwear will be included. Participants will be randomly assigned to either enhanced therapy or usual care. Enhanced therapy consists of usual care and additionally a personalized treatment approach including pressure-optimized custom-made footwear, pressure-optimized custom-made footwear for indoor use, at-home daily foot temperature monitoring, and structured education, which includes motivational interviewing and personalized feedback on adherence and self-care. Participants will be followed for 12 months. Assessments include barefoot and in-shoe plantar pressure measurements; questionnaires concerning quality of life, costs, disease, and self-care knowledge; physical activity and footwear use monitoring; and clinical monitoring for foot ulcer outcomes. The study is powered for 3 primary outcomes: foot ulcer recurrence, footwear adherence, and cost-utility, the primary clinical, patient-related, and health-economic outcome respectively. DISCUSSION This is the first study to integrate multiple interventions for ulcer prevention into a personalized state-of-the-art treatment approach and assess their combined efficacy in a randomized controlled trial in people with diabetes at high ulcer risk. Proven effectiveness, usability, and cost-utility will facilitate implementation in healthcare, improve the quality of life of high-risk people with diabetes, and reduce treatment costs. TRIAL REGISTRATION ClinicalTrials.gov NCT05236660. Registered on 11 February 2022.
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Affiliation(s)
- Lisa E Vossen
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Jaap J van Netten
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Chantal D Bakker
- Department of Rehabilitation Medicine, Máxima Medisch Centrum Veldhoven, de Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Heleen A Berendsen
- Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis Delft, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
| | - Tessa E Busch-Westbroek
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Edgar J G Peters
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Internal Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Louise W E Sabelis
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Marcel G W Dijkgraaf
- Epidemiology and Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Methodology, Amsterdam Public Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sicco A Bus
- Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Rehabilitation & Development, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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12
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Tang F, Abdul Razak SNB, Tan JX, Choke ETC, Zainudin SB. Fast-Access Multidisciplinary Approach to Management of Diabetic Foot Ulcers: The Diabetic Rapid Evaluation and Lower Limb Amputation Management (DREAM) Clinic. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231196464. [PMID: 37786405 PMCID: PMC10541744 DOI: 10.1177/11795514231196464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/13/2023] [Indexed: 10/04/2023] Open
Abstract
Background Diabetic foot ulcers (DFUs) are debilitating to the patient and costly for the healthcare system. We set up the Diabetic Rapid Evaluation and lower limb Amputation Management (DREAM) clinic with the aim of providing early directed specialist care to patients with DFUs. With early management, we hope to treat DFUs in its early stages, reducing the need for and associated morbidity of major and minor lower limb amputations. Objectives We evaluated the outcomes of the fast-access DREAM clinic with multi-disciplinary evaluation for patients with DFUs. Outcomes include time from the point of referral to DREAM clinic evaluation, amputation rates and wound healing rates. Design Patients presenting with DFU to the DREAM clinic were enrolled. A podiatrist made the first assessment, followed by immediate specialist consultation with Endocrinologists, Vascular surgeons or Orthopaedic surgeons as required. Methods Data on baseline demographics and DFU characteristics were collected. Outcomes evaluated were wound healing at 12 weeks, wound salvage rates, time to DREAM clinic access and time to specialist referral. Results Sixty-eight patients were enrolled, with 57.3% males, and mean age of 63 ± 13.0 years. Majority of ulcers were classified as neuropathic (41.3%) and located at the digits (40%). At 12-weeks follow-up, 1 had undergone major amputation, 9 minor amputations and 4 surgical debridements. The median time to DREAM clinic evaluation from first presentation was 3 days (IQR 7). Eleven (16.2%) required >1 specialist consult. Twenty (29.4%) were hospitalised for treatment. Twelve underwent revascularisation within 4 days (IQR 3.5). Twenty-four patients (35.3%) continued podiatry follow-up, having 28 DFUs in which 20 (71.4%) healed within 12 weeks. Conclusion The fast-access multidisciplinary DREAM clinic shows promising outcomes with lower major amputation rates and exemplary DFU healing outcomes.
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Affiliation(s)
- Fengjie Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Sueziani Binte Zainudin
- Department of Endocrinology, Department of General Medicine, Sengkang General Hospital, Singapore
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13
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Marques R, Lopes M, Ramos P, Neves‐Amado J, Alves P. Prognostic factors for delayed healing of complex wounds in adults: A scoping review. Int Wound J 2023; 20:2869-2886. [PMID: 36916415 PMCID: PMC10410354 DOI: 10.1111/iwj.14128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Abstract
Complex or hard-to-heal wounds continue to be a challenge because of the negative impact they have on patients, caregivers, and all the associated costs. This study aimed to identify prognostic factors for the delayed healing of complex wounds. Five databases and grey literature were the sources used to research adults with pressure ulcers/injuries, venous leg ulcers, critical limb-threatening ischaemia, or diabetic foot ulcers and report the prognostic factors for delayed healing in all care settings. In the last 5 years, a total of 42 original peer-reviewed articles were deemed eligible for this scoping review that followed the JBI recommendations and checklist PRISMA-ScR. The most frequent prognostic factors found with statistical significance coinciding with various wound aetiologies were: gender (male), renal disease, diabetes, peripheral arterial disease, the decline in activities of daily life, wound duration, wound area, wound location, high-stage WIfI classification, gangrene, infection, previous ulcers, and low ankle brachial index. It will be essential to apply critical appraisal tools and assessment risk of bias to the included studies, making it possible to make recommendations for clinical practice and build prognostic models. Future studies are recommended because the potential for healing through identification of prognostic factors can be determined, thus allowing an appropriate therapeutic plan to be developed.
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Affiliation(s)
- Raquel Marques
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
| | - Marcos Lopes
- School of Nursing DepartmentUniversidade Federal CearáFortalezaBrazil
| | - Paulo Ramos
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- Unidade de Saúde Familiar Corino de AndradePortoPortugal
| | - João Neves‐Amado
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- School of Nursing DepartmentUniversidade Católica PortuguesaPortoPortugal
| | - Paulo Alves
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- School of Nursing DepartmentUniversidade Católica PortuguesaPortoPortugal
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14
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lashkarbolouk N, Mazandarani M, Mohajeri Tehrani MR, Aalaa M, Sanjari M, Mehrdad N, Reza Amini M. Fast-Track Pathway: An Effective Way to Boost Diabetic Foot Care. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231189048. [PMID: 37529303 PMCID: PMC10388609 DOI: 10.1177/11795514231189048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot ulcer (DFU) is one of the most common causes of reduced quality of life and increased hospitalization, amputation, treatment costs, and mortality in patients. Improper patients' knowledge, unsatisfactory education and training of healthcare workers, and limited facilities are the major cause of delayed referral and downscale management in DFUs. The diabetic foot clinical pathway is pivotal in providing best practices based on the latest standards and patient preferences. In the diabetic foot clinical pathway provided by the Iran Ministry of Health, the common concepts and grading systems are well defined for diabetic foot specialists so that patients can be diagnosed correctly and referred properly. Based on clinical examination guidelines, patients with diabetes are classified into low-risk, moderate-risk, high-risk, and active diabetic foot ulcer groups. One of this Pathway's main objectives is to prevent the patient from getting the first ulcer, prevent frequent recurrence ulcers, and most importantly, prevent minor and major amputation.
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Affiliation(s)
- Narges lashkarbolouk
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Mazandarani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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15
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Agidigbi TS, Kwon HK, Knight JR, Zhao D, Lee FY, Oh I. Transcriptomic identification of genes expressed in invasive S. aureus diabetic foot ulcer infection. Front Cell Infect Microbiol 2023; 13:1198115. [PMID: 37434783 PMCID: PMC10332306 DOI: 10.3389/fcimb.2023.1198115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Infection in diabetic foot ulcers (DFUs) is one of the major complications associated with patients with diabetes. Staphylococcus aureus is the most common offending pathogen in patients with infected DFU. Previous studies have suggested the application of species-specific antibodies against S. aureus for diagnosis and monitoring treatment response. Early and accurate identification of the main pathogen is critical for management of DFU infection. Understanding the host immune response against species-specific infection may facilitate diagnosis and may suggest potential intervention options to promote healing infected DFUs. We sought to investigate evolving host transcriptome associated with surgical treatment of S. aureus- infected DFU. Methods This study compared the transcriptome profile of 21 patients with S. aureus- infected DFU who underwent initial foot salvage therapy with irrigation and debridement followed by intravenous antibiotic therapy. Blood samples were collected at the recruitment (0 weeks) and 8 weeks after therapy to isolate peripheral blood mononuclear cells (PBMCs). We analyzed the PBMC expression of transcriptomes at two different time points (0 versus 8 weeks). Subjects were further divided into two groups at 8 weeks: healed (n = 17, 80.95%) versus non-healed (n = 4, 19.05%) based on the wound healing status. DESeq2 differential gene analysis was performed. Results and discussion An increased expression of IGHG1, IGHG2, IGHG3, IGLV3-21, and IGLV6-57 was noted during active infection at 0 weeks compared with that at 8 weeks. Lysine- and arginine-rich histones (HIST1H2AJ, HIST1H2AL, HIST1H2BM, HIST1H3B, and HIST1H3G) were upregulated at the initial phase of active infection at 0 weeks. CD177 and RRM2 were also upregulated at the initial phase of active infection (0 weeks) compared with that at 8 weeks of follow-up. Genes of heat shock protein members (HSPA1A, HSPE1, and HSP90B1) were high in not healed patients compared with that in healed patients 8 weeks after therapy. The outcome of our study suggests that the identification of genes evolution based on a transcriptomic profiling could be a useful tool for diagnosing infection and assessing severity and host immune response to therapies.
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Affiliation(s)
- Taiwo Samuel Agidigbi
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
| | - Hyuk-Kwon Kwon
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
- Division of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - James R. Knight
- Yale Center for Genome Analysis, Department of Genetics, Yale School of Medicine, New Haven, CT, United States
| | - Dejian Zhao
- Yale Center for Genome Analysis, Department of Genetics, Yale School of Medicine, New Haven, CT, United States
| | - Francis Y. Lee
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
| | - Irvin Oh
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
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16
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Kinesya E, Santoso D, Gde Arya N, Putri Cintya E, Seriari Ambarini P, Kinesya B, Stephanie Kartjito M, Mannagalli Y. Vitamin D as adjuvant therapy for diabetic foot ulcers: Systematic review and meta-analysis approach. Clin Nutr ESPEN 2023; 54:137-143. [PMID: 36963855 DOI: 10.1016/j.clnesp.2023.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/19/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diabetic Foot Ulcer (DFU) is a combination of neuropathy and ischaemia on diabetic patient's lower limbs. It has a high burden of limb amputation rate, mortality rate, disability, economic burden, and lower quality of life on diabetic patients. It took mostly 3-6 months and up to 1 year for DFU to heal. DFU patients also have an increased risk of vitamin D deficiency. Meanwhile vitamin D has effects on immune response, insulin secretion, and sensitivity. The long duration of DFU healing is a problem for the patient's health, job, income, quality of life, economy and healthcare. Therefore, we aim to conduct a meta-analysis to assess reliability of vitamin D supplementation on diabetic foot ulcer clinical outcome. METHODS We conducted systematic literature search according to PRISMA guideline on Cochrane Library, PubMed, Google Scholar, ProQuest, EBSCO and ScienceDirect from 16 until 24 June 2022. Effect of vitamin D supplementation on diabetic foot ulcer patients was analyzed with a comprehensive meta-analysis tool. Pooled ulcer area, total cholesterol, triglyceride, C-reactive protein, HbA1c, and fasting plasma glucose assessed with 95% confidence intervals were estimated using fixed-effects or random-effects models. RESULTS We included 4 papers with 197 people as sample reporting vitamin D capability as treatment for DFU patients. The pooled analysis showed significant differences in ulcer area, serum Vitamin D, Total Cholesterol, Fasting Plasma Glucose, Triglyceride, C-Reactive Protein, and HbA1c. Insignificant results on Erythrocyte Sedimentation Rate and High Density Lipoprotein levels. CONCLUSION Vitamin D supplementation is beneficial to be given as adjuvant treatment for diabetic foot ulcer. It may fasten the wound healing and decrease the burden caused by diabetic foot ulcers.
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Affiliation(s)
- Edwin Kinesya
- Medical Faculty of Universitas Brawijaya, Malang, Indonesia
| | - Donni Santoso
- Medical Faculty of Universitas Brawijaya, Malang, Indonesia
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17
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Vahwere BM, Ssebuufu R, Namatovu A, Kyamanywa P, Ntulume I, Mugwano I, Pius T, Sikakulya FK, Xaviour OF, Mulumba Y, Jorge S, Agaba G, Nasinyama GW. Factors associated with severity and anatomical distribution of diabetic foot ulcer in Uganda: a multicenter cross-sectional study. BMC Public Health 2023; 23:463. [PMID: 36899359 PMCID: PMC9999659 DOI: 10.1186/s12889-023-15383-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) that is associated with increased mortality, morbidity, amputation rate and economic burden. This study aimed at identifying the anatomical distribution and factors associated with severity of DFU in Uganda. METHODOLOGY This was a multicenter cross-sectional study conducted in seven selected referral hospitals in Uganda. A total of 117 patients with DFU were enrolled in this study between November 2021 and January 2022. Descriptive analysis and modified Poisson regression analysis were performed at 95% confidence interval; factors with p-value < 0.2 at bivariate analysis were considered for multivariate analysis. RESULTS The right foot was affected in 47.9% (n = 56) of patients, 44.4% (n = 52) had the DFU on the plantar region of the foot and 47.9% (n = 56) had an ulcer of > 5 cm in diameter. The majority (50.4%, n = 59) of patients had one ulcer. 59.8% (n = 69) had severe DFU, 61.5% (n = 72) were female and 76.9% had uncontrolled blood sugar. The mean age in years was 57.5 (standard deviation 15.2 years). Primary (p = 0.011) and secondary (p < 0.001) school educational levels, moderate (p = 0.003) and severe visual loss (p = 0.011), 2 ulcers on one foot (p = 0.011), and eating vegetables regularly were protective against developing severe DFU (p = 0.03). Severity of DFU was 3.4 and 2.7 times more prevalent in patients with mild and moderate neuropathies (p < 0.01), respectively. Also, severity was 1.5 and 2.5 higher in patients with DFU of 5-10 cm (p = 0.047) and in those with > 10 cm diameter (p = 0.002), respectively. CONCLUSION Most DFU were located on the right foot and on the plantar region of the foot. The anatomical location was not associated with DFU severity. Neuropathies and ulcers of > 5 cm diameter were associated with severe DFU but primary and secondary school education level and eating vegetables were protective. Early management of the precipitating factors is important to reduce the burden of DFU.
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Affiliation(s)
| | | | - Alice Namatovu
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Ibrahim Ntulume
- Kampala International University, Western Campus, Kampala, Uganda.,College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Isaac Mugwano
- Fortportal Regional Referral Hospital, Fort portal, Uganda
| | - Theophilus Pius
- Kampala International University, Western Campus, Kampala, Uganda
| | - Franck Katembo Sikakulya
- Kampala International University, Western Campus, Kampala, Uganda.,Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | | | | | - Soria Jorge
- Kampala International University, Western Campus, Kampala, Uganda
| | - Gidio Agaba
- Kiruddu National Referral Hospital, Kampala, Uganda
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18
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Brennan MB, Tan TW, Schechter MC, Fayfman M. Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations. Semin Vasc Surg 2023; 36:19-32. [PMID: 36958894 PMCID: PMC10039286 DOI: 10.1053/j.semvascsurg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Recently, the United States experienced its first resurgence of major amputations in more than 20 years. Compounding this rise is a longstanding history of disparities. Patients identifying as non-Hispanic Black are twice as likely to lose a limb as those identifying as non-Hispanic White. Those identifying as Latino face a 30% increase. Rural patients are also more likely to undergo major amputations, and the rural-urban disparity is widening. We used the National Institute on Minority Health and Health Disparities framework to better understand these disparities and identify common factors contributing to them. Common factors were abundant and included increased prevalence of diabetes, possible lower rates of foot self-care, transportation barriers to medical appointments, living in disadvantaged neighborhoods, and lack of insurance. Solutions within and outside the health care realm are needed. Health care-specific interventions that embed preventative and ambulatory care services within communities may be particularly high yield.
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Affiliation(s)
- Meghan B Brennan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53583.
| | - Tze-Woei Tan
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Marcos C Schechter
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
| | - Maya Fayfman
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
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19
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Validation of the Fast-Track Model: A Simple Tool to Assess the Severity of Diabetic Foot Ulcers. J Clin Med 2023; 12:jcm12030761. [PMID: 36769408 PMCID: PMC9917528 DOI: 10.3390/jcm12030761] [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: 12/14/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
This study aimed to validate the association between the grades of severity of diabetic foot ulcers (DFUs) identified by the fast-tack model and specific outcomes. Three hundred and sixty-seven patients with new DFUs who were referred to a tertiary level diabetic foot service serving Rome, Italy, were included. The fast-track model identifies three levels of DFUs' severity: uncomplicated DFUs, including superficial wounds, not-infected wounds, and not-ischemic wounds; complicated DFUs, including ischemic wounds, infected wounds, and deep ulcers involving the muscles, tendons, or bones, and any kind of ulcers in patients on dialysis and/or with heart failure; and severely complicated DFUs, including abscesses, wet gangrene, necrotizing fasciitis, fever, or clinical signs of sepsis. Healing, minor and major amputation, hospitalization, and survival after 24 weeks of follow-up were considered. Among the included patients, 35 (9.6%) had uncomplicated DFUs, 210 (57.2%) had complicated DFUs, and 122 (33.2%) had severely complicated DFUs. The outcomes for patients with uncomplicated, complicated, and severely complicated DFUs were as follows, respectively: healing, 97.1%, 86.2%, and 69.8%; minor amputation, 2.9%, 20%, and 66.4%; major amputation, 0%, 2.9%, and 16.4%; hospitalization, 14.3%, 55.7%, and 89.3%; survival, 100%, 96.7%, and 89.3%. DFU severity was an independent predictor of healing, amputation, hospitalization, and survival. The current study shows an association between the grade of severity of DFUs identified by the fast-track model and the considered outcomes. The fast-track model may be a useful tool for assessing the severity and prognosis of DFUs.
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20
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New Paradigm in Diabetic Foot Ulcer Grafting Techniques Using 3D-Bioprinted Autologous Minimally Manipulated Homologous Adipose Tissue (3D-AMHAT) with Fibrin Gel Acting as a Biodegradable Scaffold. Gels 2023; 9:gels9010066. [PMID: 36661832 PMCID: PMC9858307 DOI: 10.3390/gels9010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Adipose tissue is an abundant source of extracellular substances that support the tissue repair process. This pilot study was carried out to determine the efficacy of 3D-bioprinted autologous adipose tissue grafts on diabetic foot ulcers (DFUs), with fibrin gel used to stabilise the graft. This was a single-arm pilot study in a tertiary hospital that provides diabetic wound care services. A total of 10 patients with a DFU were enrolled, and the primary endpoint was complete healing within 12 weeks. The secondary endpoints were wound size reduction, time to healing, and adverse events. Seven out of ten patients showed complete healing of their DFU within 12 weeks (at 2, 4, 5, 10, and 12 weeks, respectively). The wound size reduction rate was significantly and progressively reduced over time. According to our data, autologous adipose tissue grafting using a 3D bioprinter, with the addition of fibrin gel that acts as a scaffold, promotes wound healing with high-quality skin reconstruction. Throughout this study period, no adverse events were observed.
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Tehan PE, Burrows T, Hawes MB, Linton C, Norbury K, Peterson B, Walsh A, White D, Chuter VH. Factors influencing diabetes-related foot ulcer healing in Australian adults: A prospective cohort study. Diabet Med 2023; 40:e14951. [PMID: 36054775 PMCID: PMC10087534 DOI: 10.1111/dme.14951] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Diabetes-related foot ulceration (DFU) is a common limb-threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to the healing of diabetes-related foot ulceration in an Australian population. RESEARCH DESIGN AND METHODS This was a prospective cohort study of individuals with diabetes-related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. The index of relative socio-economic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire-short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over 6 months. Logistic regression was performed to determine the relationship between healing and diet quality, toe systolic pressure, wound size at, IRSD, infection and previous amputation. RESULTS A total of 117 participants were included. The majority were male n = 96 (82%), socio-economically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36 kg/m2 , SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n = 85, 73%) and classified 1A (n = 63, 54%) on the University of Texas wound classification system with few infections (n = 23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95% 1.28-14.84, p = 0.02), and greater levels of socio-economic advantage were also associated with increased odds of healing (OR 1.01, 95% CI 1.01-1.02, p = 0.03). CONCLUSIONS In this cohort study of predominantly neuropathic, non-infected DFU, individuals who had greater levels of socio-economic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal.
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Affiliation(s)
- Peta Ellen Tehan
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Allied Health, Monash University, Clayton, Victoria, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Morgan Brian Hawes
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Clare Linton
- Gosford Hospital High Risk Foot Clinic, Central Coast Local Health District, Gosford, UK
| | - Kate Norbury
- Wyong Hospital High Risk Foot Clinic, Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Benjamin Peterson
- School of Health, Medical and Applied Sciences, CQUniversity Australia, North Rockhampton, Queensland, Australia
| | - Annie Walsh
- Liverpool High Risk Foot Clinic, South Western Sydney Local health District, Kogarah, New South Wales, Australia
| | - Diane White
- John Hunter Hospital High Risk Foot Clinic, Hunter New England Local health District, New Lambton, New South Wales, Australia
| | - Vivienne Helaine Chuter
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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22
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Shi L, Xue J, Zhao W, Wei X, Zhang M, Li L, Xu Z, Wang A. The Prognosis of Diabetic Foot Ulcer is Independent of age? A Comparative Analysis of the Characteristics of Patients with Diabetic Foot Ulcer in Different age Groups: A Cross-Sectional Study from China. INT J LOW EXTR WOUND 2022:15347346221125844. [PMID: 36184913 DOI: 10.1177/15347346221125844] [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: 12/10/2022]
Abstract
Background: With younger onset age of type 2 diabetes mellitus (T2DM), the incidence of diabetic foot ulcer (DFU) in young and middle-aged adults is also increasing. Elucidating the distinctive characteristics of DFU in different ages and exploring the influence of age on the prognosis of DFU are crucial to the improvement of DFU treatments. Methods: 684 patients hospitalized for DFU in the department of endocrinology were recruited and assigned into the young and middle-aged group (age <65 years old) and the elderly group (age ≥65 years old). Demographic data and clinical features were compared between two groups. Results: Compared with the elderly group, the young and middle-aged group had higher proportion of males (72.3% vs 49.6%, P < .01) and smokers (52.5% vs 35.8%, P < .01), shorter duration of diabetes mellitus (155 months vs 196 months, P < .01), higher levels of glycosylated hemoglobin (9.3% vs 8.7%, P < .01), lower ratio of ankle-brachial index <0.9 (25.8% vs 51.1%, P < .01) and higher levels of c-reactive protein and erythrocyte sedimentation rate (14 mg/L vs 10 mg/L, P < .05; 36 mm/h vs 30 mm/h, P < .05). The prevalence of diabetic peripheral neuropathy and Wagner Grade were similar in two groups. Of note, the prognosis was similar in different age groups, as there were no significant differences in the healing rate (59.7% vs 60.1%, P > .05), healing time (30 days vs 22 days, P > .05) and minor amputation rate (11.9% vs 8.7%, P > .05). Conclusions: We found that no evidence to suggest a better prognosis with younger DFU patients. Compared with elderly ones, young and middle-aged patients were characterized by a higher proportion of smoking, worse glycemic control, higher inflammatory biomarkers but less severe lower limb ischemia, indicating that smoking cessation, strict blood glucose control and early detection of infection were crucial for improving the prognosis of young and middle-aged diabetic DFU patients.
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Affiliation(s)
- Lintao Shi
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Jing Xue
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
- 306th Clinical College of PLA, The Fifth Clinical Medical College, Anhui Medical University, Beijing, China
| | - Weibo Zhao
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
- 306th Clinical College of PLA, The Fifth Clinical Medical College, Anhui Medical University, Beijing, China
| | - Xiaowei Wei
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Mei Zhang
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Lijun Li
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Zhangrong Xu
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
| | - Aihong Wang
- Diabetes Center of People's Liberation Army (PLA), Department of Endocrinology, PLA Strategic Support Force Medical Center, Beijing, China
- 306th Clinical College of PLA, The Fifth Clinical Medical College, Anhui Medical University, Beijing, China
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Mbela Lusendi F, Matricali GA, Vanherwegen AS, Doggen K, Nobels F. Bottom-up approach to build a 'precision' risk factor classification for diabetic foot ulcer healing. Proof-of-concept. Diabetes Res Clin Pract 2022; 191:110028. [PMID: 35926667 DOI: 10.1016/j.diabres.2022.110028] [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: 07/18/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
AIMS Diabetic foot ulcers (DFU) have a complex multifactorial pathophysiology. It is crucial to identify essential prognostic variables to streamline therapeutic actions and quality-of-care audits. Although SINBAD and University of Texas (UT), the most frequently used prognostic classification systems, were prospectively validated, not all individual parameters were shown to have consistent associations with healing. In this study, we used a bottom-up approach relying on robust methods to identify independent predictors of DFU healing. METHODS 1,664 DFU patients were included by 34 Belgian diabetic foot clinics (DFCs). Twenty-one patient- and foot-related characteristics were recorded at presentation. Predictors of healing were identified using multivariable Cox proportional hazard regression. Multivariable models were built using backward regression with multiple imputation of missing values and bootstrapping. RESULTS Five essential independent variables were identified: presentation delay, history of minor amputation, ulcer location, surface area and ischemia. This 5 variable-model showed a better performance compared to models based on existing classification systems. CONCLUSIONS A bottom-up approach was used to build a prognostic classification for DFU healing based on large databases. It offers new insights and allows to tailor the classification to certain clinical settings. These 5 parameters could be used as a 'precision classification' for specialized DFCs.
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Affiliation(s)
- Flora Mbela Lusendi
- Health Services Research, Sciensano, Brussel, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - Giovanni Arnoldo Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Multidisciplinary Diabetic Foot Clinic, University Hospital Leuven, Leuven, Belgium.
| | | | - Kris Doggen
- Health Services Research, Sciensano, Brussel, Belgium
| | - Frank Nobels
- Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.
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24
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Selçuk Tosun A, Akgül Gündoğdu N, Taş F, Ateş S. Experiences, thoughts, and feelings of patients with a diabetic foot ulcer in Turkey: A qualitative descriptive study. JOURNAL OF VASCULAR NURSING 2022; 40:140-147. [DOI: 10.1016/j.jvn.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/22/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
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25
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Fritz BG, Kirkegaard JB, Nielsen CH, Kirketerp-Møller K, Malone M, Bjarnsholt T. Transcriptomic fingerprint of bacterial infection in lower extremity ulcers. APMIS 2022; 130:524-534. [PMID: 35567538 PMCID: PMC9545044 DOI: 10.1111/apm.13234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/11/2022] [Indexed: 12/22/2022]
Abstract
Clinicians and researchers utilize subjective, clinical classification systems to stratify lower extremity ulcer infections for treatment and research. The purpose of this study was to examine whether these clinical classifications are reflected in the ulcer's transcriptome. RNA sequencing (RNA‐seq) was performed on biopsies from clinically infected lower extremity ulcers (n = 44). Resulting sequences were aligned to the host reference genome to create a transcriptome profile. Differential gene expression analysis and gene ontology (GO) enrichment analysis were performed between ulcer severities as well as between sample groups identified by k‐means clustering. Lastly, a support vector classifier was trained to estimate clinical infection score or k‐means cluster based on a subset of genes. Clinical infection severity did not explain the major sources of variability among the samples and samples with the same clinical classification demonstrated high inter‐sample variability. High proportions of bacterial RNA were identified in some samples, which resulted in a strong effect on transcription and increased expression of genes associated with immune response and inflammation. K‐means clustering identified two clusters of samples, one of which contained all of the samples with high levels of bacterial RNA. A support vector classifier identified a fingerprint of 20 genes, including immune‐associated genes such as CXCL8, GADD45B, and HILPDA, which accurately identified samples with signs of infection via cross‐validation. This study identified a unique, host‐transcriptome signature in the presence of infecting bacteria, often incongruent with clinical infection‐severity classifications. This suggests that stratification of infection status based on a transcriptomic fingerprint may be useful as an objective classification method to classify infection severity, as well as a tool for studying host–pathogen interactions.
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Affiliation(s)
- Blaine G Fritz
- Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Claus Henrik Nielsen
- Department of Rheumatology and Spine Diseases, Institute for Inflammation Research, Rigshospitalet, Copenhagen, Denmark
| | | | - Matthew Malone
- South West Sydney Limb Preservation and Wound Research, Liverpool Hospital, Sydney, Australia.,Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
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26
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Baines D, Carter M, Pimlott B, Reilly M. Effectiveness of testing hard-to-heal wounds for bacterial protease activity: a randomised clinical trial. J Wound Care 2022; 31:398-405. [PMID: 35579313 DOI: 10.12968/jowc.2022.31.5.398] [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: 11/11/2022]
Abstract
OBJECTIVE The study aimed to evaluate whether using a point-of-care test for bacterial protease activity (BPA) to target antimicrobial dressing use can improve outcomes for hard-to-heal wounds and reduce cost. METHOD Wounds asymptomatic for infection and testing positive for BPA were randomly assigned to two weeks' treatment with a silver antimicrobial dressing in addition to standard of care (SoC) (intervention group) or to SoC only (control group). The patient's outcomes were monitored for 12 weeks. RESULTS The study included 100 wounds. A reduction in annualised nursing resource of 29.0% (95% confidence interval (CI): 1.9-34.1) for hard-to-heal wounds was predicted for the intervention versus control group (44±25.10 intervention group nurse/clinic visits versus 62±31.23 control group nurse/clinic visits; p=0.034). The percentage of patients reporting problems reduced for all EQ5D-3L dimensions for the intervention group, with the largest reductions in 'pain/discomfort' (-36.2%) and 'anxiety/depression' (-19.1%). Prescription of antibiotics fell by 45% for wound-related infections in the intervention group compared with the control group. In the intervention group the number of patients who did not receive a prescription was 37/50 (74%), nine (18%) patients received one prescription and four (8%) patients received two or more prescriptions. In the control group 29/50 (58%) patients did not receive a prescription, 12 (24%) received one prescription and nine (18%) patients received two or more prescriptions; p=0.068. CONCLUSION The utility of the BPA test to reduce predicted annualised nursing time was demonstrated. The strong trend towards reduced antibiotic prescribing and improved quality of life for patients with wounds treated for BPA deserves further study.
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Affiliation(s)
- Deborah Baines
- National Institute for Health Research Clinical Research Network (Greater Manchester), UK
| | | | | | - Mkyla Reilly
- Public Health England North West, Manchester, UK
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27
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Monami M, Ragghianti B, Nreu B, Lorenzoni V, Pozzan M, Silverii A, Turchetti G, Mannucci E. Major Amputation In Non-Healing Ulcers: Outcomes and Economic Issues. Data from a Cohort of Patients with Diabetic Foot Ulcers. INT J LOW EXTR WOUND 2022:15347346221097283. [PMID: 35477285 DOI: 10.1177/15347346221097283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Foot ulcers have a relevant economic impact on Health Care Systems and the cost-effectivenesseffectiveness of options is not clear. The aim of this study was the assessment of costs for ulcers treatment after 6, 12, and 18 months of follow-up, compared to those for major amputation. Methods: A retrospective study was carried out on 196 types 2 diabetic patients with foot ulcers. The principal endpoints were 1) the proportion of recovered patients among those with ulcers not healed after 6 and 12 months; 2) the assessment of direct costs for treatment of ulcers 6, 12, and 18 months of follow-up, as compared to the cost of major amputation. The economic evaluation was performed considering the perspective of the local health system. Results: Out of 196 patients, 85(46.2%), 131(71.6%), and 140(85.9%) healed within 6, 12, and 18 months, respectively. The average health cost during the 18-month follow-up was 5402€ per patient. We calculated hypothetical costs for three different scenarios, in which patients who did not heal within 6 months underwent a major amputation at 6, 1,2, or 18 months. Costs for the standard of care for all these scenarios (6,094, 7,256, and 7649€ for 6, 12, or 18 months, respectively) were significantly lower than that for major amputations (21,065€). Conclusions: A conservative approach appears more convenient than major amputations in ulcers not healing after 6 months, irrespective of the estimated risk of individual patients.
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Affiliation(s)
- Matteo Monami
- Diabetology, 18561Careggi Hospital and University of Florence, Firenze, Italy
| | | | - Besmir Nreu
- Diabetology, 18561Careggi Hospital and University of Florence, Firenze, Italy
| | | | - Marco Pozzan
- Diabetology, 18561Careggi Hospital and University of Florence, Firenze, Italy
| | - Antonio Silverii
- Diabetology, 18561Careggi Hospital and University of Florence, Firenze, Italy
| | | | - Edoardo Mannucci
- Diabetology, 18561Careggi Hospital and University of Florence, Firenze, Italy
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28
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Bhadauria SS, Malviya R. Advancement in Nanoformulations for the Management of Diabetic Wound Healing. Endocr Metab Immune Disord Drug Targets 2022; 22:911-926. [PMID: 35249512 DOI: 10.2174/1871530322666220304214106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/01/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
People with diabetes have a very slow tendency for wound healing. Wound healing is a vast process where several factors inhibit the sequence of healing. Nano formulation plays a major role during acute and chronic wound healing. The present manuscript aims to discuss the role of nanoformulation in the treatment of diabetic wound healing. Diabetes is a common disease that has harmful consequences which lead to bad health. During the literature survey, it was observed that nanotechnology has significant advantages in the treatment of diabetic wound healing. The present manuscript summarized the role of nanomaterials in wound healing, challenges in diabetic wound healing, physiology of wound healing, a limitation that comes during wound repair, and treatments available for wound healing. After a comprehensive literature survey, it can be concluded that health worker needs more focus on the area of wound healing in diabetic patients. Medical practitioners, pharmaceutical and biomedical researchers need more attention towards the utilization of nanoformulations for the treatment of wound healing, specifically in the case of diabetes.
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Affiliation(s)
- Shailendra Singh Bhadauria
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
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29
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Zhu X, Lee M, Chew EAL, Goh LJ, Dong L, Bartlam B. "When nothing happens, nobody is afraid!" beliefs and perceptions around self-care and health-seeking behaviours: Voices of patients living with diabetic lower extremity amputation in primary care. Int Wound J 2021; 18:850-861. [PMID: 33955156 PMCID: PMC8613372 DOI: 10.1111/iwj.13587] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Self-management and self-care are the cornerstone of diabetes care and an essential part of successfully preventing or delaying diabetes complications. Yet, despite being armed with the required information and guidance for self-management, self-care and adherence to foot self-care recommendations and compliance to medication among patients with diabetic foot ulcer and diabetic lower extremity amputations remain low and suboptimal. This study reveals in-depth account of nine such patients' beliefs and perceptions around their illness, their self-care, and their health-seeking behaviours. Patients living with diabetic lower extremity amputation displayed profound lack of knowledge of self-care of diabetes and foot and passive health-related behaviours. The overarching sense that "when nothing happens, nobody is afraid," points to a lack of motivation in taking charge of one's own health, whether this is with reference to treatment or care adherence, following recommended self-care advice, or seeking timely treatment. The Health Beliefs Model provides the theoretical framework for probing into the factors for the participants' suboptimal self-care and passive health-seeking behaviours. Two themes emerged from data analysis: profound knowledge deficit and passive health-related behaviours. The beliefs and perceptions around self-care and health-seeking behaviours for patients with lower extremity amputation are interpreted as the "ignorant self" with passive health-seeking behaviours. Patients with diabetes and diabetic foot diseases may benefit from personalized education, motivational interviewing, and family support.
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Affiliation(s)
- Xiaoli Zhu
- Nursing ServicesNational Healthcare Group PolyclinicsSingapore
| | - Mary Lee
- Health Outcomes and Medical Education ResearchNational Healthcare GroupSingapore
| | - Evelyn AL Chew
- Clinical Research UnitNational Healthcare Group PolyclinicsSingapore
| | - Ling Jia Goh
- Nursing ServicesNational Healthcare Group PolyclinicsSingapore
| | - Lijuan Dong
- Nursing ServicesNational Healthcare Group PolyclinicsSingapore
| | - Bernadette Bartlam
- Family Medicine and Primary Care, Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
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30
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Bouillet B, Ahluwalia R, Iacopi E, Garcia-Klepzig JL, Lüdemann C, Manu C, Meloni M, Saenz De Buruaga VR, Vouillarmet J, Petit JM, Van Acker K, Lázaro-Martínez JL. Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays. J Wound Care 2021; 30:804-808. [PMID: 34644141 DOI: 10.12968/jowc.2021.30.10.804] [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: 11/11/2022]
Abstract
OBJECTIVE Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. METHOD In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. RESULTS Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004). CONCLUSION The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Benjamin Bouillet
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Dijon, France.,Unité INSERM, LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | | | - Elisabetta Iacopi
- University of Pisa, Ospedale di Cisanello, via Paradisa 2, 56126 Pisa, Italy
| | | | - Claas Lüdemann
- Franziskus Krankenhaus Berlin, Budapester Strasse, 15-19, 10787 Berlin, Germany
| | - Chris Manu
- King's College Hospital, Denmark Hill, London, UK
| | - Marco Meloni
- University of Roma Tor Vergata, Viale Oxford 81, 00133 Roma, Italy
| | | | - Julien Vouillarmet
- CHU Lyon Sud, Pavillon Médical, 165 chemin du Grand Revoyet 69495 Pierre Bénite, France
| | - Jean-Michel Petit
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Dijon, France.,Unité INSERM, LNC-UMR 1231, Université de Bourgogne, Dijon, France
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31
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Bouillet B, Meloni M, Ahluwalia R. Improving referral of patients with diabetic foot ulcer to specialised diabetes foot care units. J Wound Care 2021; 30:782-784. [PMID: 34644130 DOI: 10.12968/jowc.2021.30.10.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin Bouillet
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France; INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | | | - Raju Ahluwalia
- Department of Orthopaedics and King's Diabetes Foot Clinic, King's College Hospital, Denmark Hill, London, UK
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32
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Meloni M, Lazaro-Martínez JL, Ahluwalia R, Bouillet B, Izzo V, Di Venanzio M, Iacopi E, Manu C, Garcia-Klepzig JL, Sánchez-Ríos JP, Lüedemann C, De Buruaga VRS, Vouillarmet J, Guillaumat J, Aleandri AR, Giurato L, Edmonds M, Piaggesi A, Van Acker K, Uccioli L. Effectiveness of fast-track pathway for diabetic foot ulcerations. Acta Diabetol 2021; 58:1351-1358. [PMID: 33942178 PMCID: PMC8413149 DOI: 10.1007/s00592-021-01721-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 01/22/2023]
Abstract
AIM To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. METHODS The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. RESULTS Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. CONCLUSION After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.
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Affiliation(s)
- Marco Meloni
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | | | - Raju Ahluwalia
- Department of Trauma and Ortophaedic Department, King ́s College Hospital, London, UK
| | | | - Valentina Izzo
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | - Elisabetta Iacopi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | - Chris Manu
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | | | | | | | | | | | | | | | - Laura Giurato
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Micheal Edmonds
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | - Alberto Piaggesi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | | | - Luigi Uccioli
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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Shaheen MMA, Al Dahab S, Abu Fada M, Idieis R. Isolation and characterization of bacteria from diabetic foot ulcer: amputation, antibiotic resistance and mortality rate. Int J Diabetes Dev Ctries 2021; 42:529-537. [PMID: 34522073 PMCID: PMC8431256 DOI: 10.1007/s13410-021-00997-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/23/2021] [Indexed: 10/25/2022] Open
Abstract
Background Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus with devastating outcomes. Poorly treated DFU leads to osteomyelitis, gangrene and limb amputation. There is an increased risk of mortality for the amputees and increased number of bacterial resistance in survived patients. Struggle on choice of the best antibiotic(s) for DFU is escalating. Objectives To determine risk factors associated with mortality in patients with DFU. To investigate bacterial drug resistance in survived or deceased patients around amputation. Methodology This is a retrospective cohort study that involved all diabetic patients who had DFU or minor or major amputation at Hebron Governmental Hospital from 2013 to 2020. Antibiotic use and bacterial isolates along with culture and sensitivity test results were retrieved from patients' profiles and laboratory records. Major outcome of study was survival rate around amputation. Patients who missed test results for FBS or HbAc1, or who had no wound culture were excluded. SPSS version 22 was used to analyze data. Results Eighty four subjects were included in this study, 64.8 ± 12.58 years old, 63.1% males who had diabetic foot ulcer, minor or major limb amputation between 2013 and 2020 at Hebron Governmental Hospital. Forty tow patients (50%) had diabetic foot ulcer, 28 patients (33.3%) had major limb amputation, and 14 patients (16.7%), succumbed to minor amputation. Average FBS was 292.8 ± 136.33 mg/dl and average HbA1C was 8.55 ± 1.89%. Mortality rate was 9.5%. Using the Chi square test, we found a significant relationship between mortality and type of isolated bacteria, p = 0.033 and between diabetic complications (nephropathy) and mortality, p = 0.033. There was a significant relationship between antibiotic use and mortality, p = 0.04, especially with metronidazole and colistin, if they were used around limb amputation. Conclusions Mortality of diabetic patients with DFU was associated with nephropathy and Acinetobacter or E. coli infections.
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Affiliation(s)
- Muamar M A Shaheen
- Clinical Pharmacy and Practice, Faculty of Pharmacy and Medical Sciences, Hebron University, P.O Box 40, Hebron, West Bank 00972 Palestine
| | - Sewar Al Dahab
- Clinical Pharmacy and Practice, Faculty of Pharmacy and Medical Sciences, Hebron University, P.O Box 40, Hebron, West Bank 00972 Palestine
| | - Maryiam Abu Fada
- Clinical Pharmacy and Practice, Faculty of Pharmacy and Medical Sciences, Hebron University, P.O Box 40, Hebron, West Bank 00972 Palestine
| | - Rawand Idieis
- Clinical Pharmacy and Practice, Faculty of Pharmacy and Medical Sciences, Hebron University, P.O Box 40, Hebron, West Bank 00972 Palestine
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Lalieu RC, Mulder W, Raap RDB, Stolk S, Smit C, Dubois EF, van Hulst RA. Hyperbaric oxygen treatment for University of Texas grade 3 diabetic foot ulcers: a retrospective cohort study. J Wound Care 2021; 30:722-728. [PMID: 34554839 DOI: 10.12968/jowc.2021.30.9.722] [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: 11/11/2022]
Abstract
AIM Hard-to-heal diabetic foot ulcers (DFUs) may increase the risk of amputation. This study reports the positive influence of hyperbaric oxygen therapy (HBOT) on hard-to-heal DFUs involving underlying bone. METHOD A single-centre, retrospective cohort study reporting the results of HBOT and wound care on hard-to-heal University of Texas grade 3 DFUs (i.e., involving underlying bone) between 2013 and 2019. Outcome measures were primarily (near-) complete wound healing (i.e., ≥80% ulcer surface area reduction) and amputation rate (minor or major), and secondarily the number of hyperbaric sessions and improvement in quality of life (QoL) and pain score. RESULTS The study included 206 patients, of whom 74 (36%) achieved complete wound healing, and 75 (36%) near-complete healing. Amputations were performed in 27 patients (13%): 12 (6%) minor and 15 (7%) major. The median number of HBOT sessions was 42. Participants who achieved complete healing received a median of 43 sessions, compared with 10 for those who required major amputation. Patients with at least 30 sessions were less likely to undergo amputation (odds ratio: 0.08; 95% confidence interval (CI): 0.03-0.21). Mean QoL increased by 7.6 points (95%CI: 3.9-11.3; p<0.01) and median pain score fell from 3 to 1 (0-3) (p<0.01). CONCLUSIONS The addition of HBOT to standard wound care may lead to a decreased amputation risk, improved wound healing and increased QoL for people with a University of Texas grade 3 DFU. An adequate number of HBOT sessions is required to achieve optimal clinical results. Objective selection criteria and shared decision-making are suggested to improve dropout rates.
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Affiliation(s)
- Rutger C Lalieu
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands.,Amsterdam University Medical Centers, Department of Anesthesiology, Amsterdam, the Netherlands
| | - Willem Mulder
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands
| | | | - Saskia Stolk
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands
| | - Casper Smit
- Hyperbaar Geneeskundig Centrum, Rijswijk, the Netherlands.,Reinier de Graaf Gasthuis, Department of Surgery, Delft, the Netherlands
| | | | - Rob A van Hulst
- Amsterdam University Medical Centers, Department of Anesthesiology, Amsterdam, the Netherlands.,Amsterdam University Medical Centers, Department of Surgery, Hyperbaric Dept, Amsterdam, the Netherland
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Ouyang W, Jia Y, Jin L. Risk factors of diabetic foot ulcer in patients with type 2 diabetes: a retrospective cohort study. Am J Transl Res 2021; 13:9554-9561. [PMID: 34540078 PMCID: PMC8430198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/23/2021] [Indexed: 06/13/2023]
Abstract
The aim of this study is to investigate the risk factors of diabetic foot ulcer (DFU) in patients with Type 2 diabetes. Baseline characteristics of DFU-free patients with Type 2 diabetes were retrospectively collected and DFU was identified during the follow-up. Incidence of DFU was calculated and cumulative incidence was estimated by Kaplan-Meier method. Cox regression model was used to explore factors associated with DFU. A total of 980 patients were included with a median follow-up time of 28.7 months. 259 (26.4%) patients developed DFU with an incidence rate of 11.3 per 100 person-years. The cumulative incidences of DFU at 1 year and 2 years during the follow-up were 5.4% (95% CI 3.9-6.9%) and 14.1% (95% CI 11.7-16.5%), respectively. Cox regression analysis indicated that factors associated with developing DFU included age (hazard ratio (HR)=1.06, 95% CI 1.05-1.07, per 1-year increase), body mass index (HR=1.05, 95% CI 1.02-1.07), higher level of education (HR=0.77, 95% CI 0.60-0.98), hypertension (HR=1.90, 95% CI 1.47-2.45), hyperlipidemia (HR=2.63, 95% CI 2.02-3.43), coronary heart disease (HR=2.88, 95% CI 2.22-3.75), heart failure (HR=2.47, 95% CI 1.91-3.20), stroke (HR=2.44, 95% CI 1.86-3.19), diabetic retinopathy (HR=1.86, 95% CI 1.40-2.48), diabetic kidney disease (HR=1.89, 95% CI 1.41-2.53), diabetic neuropathy (HR=1.73, 95% CI 1.31-2.30), poor glycemic control (HR=1.13, 95% CI 1.07-1.19, per 1% glycosylated hemoglobin increase), and course of diabetes (HR=1.01, 95% CI 1.00-1.01, per 1-month increase). The results showed a relatively high incidence of DFU, and revealed several baseline characteristics identified as risk factors of developing DFU.
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Affiliation(s)
- Wenjuan Ouyang
- Department of Wound Repair and Plastic Burn, Wuhan University People’s Hospital (Hanchuan People’s Hospital)Xiaogan 431600, Hubei, China
| | - Yiming Jia
- Department of General Surgery, Wuhan University People’s Hospital (Hanchuan People’s Hospital)Xiaogan 431600, Hubei, China
| | - Lingli Jin
- Department of Traditional Chinese Medicine, Wuhan University People’s Hospital (Hanchuan People’s Hospital)Xiaogan 431600, Hubei, China
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Dmitriyeva M, Kozhakhmetov SK, Turebayev DK, Urazova SN, Omarov TM, Igissinov NS, Toleubayev MT. Monitoring and Prevention the Risk of Diabetic Foot Ulcer Infection during Coronavirus Disease-19 Pandemic: A Narrative Review and Perspective Algorithm. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The coronavirus disease (COVID)-19 pandemic leads to significant changes in the healthcare system and undermining best practices for maintaining a diabetic limb. A large number of patients with diabetic foot are left without timely medical care and are at increased risk of complications, hospitalization, lower limb amputation, and death. A new paradigm must be adopted for the transition from inpatient care to community-based care. The introduction of a pandemic remote management for patients with diabetic foot ulcer includes an assessment of the risk of complications through telemedicine and further stratification of patients according to the developed algorithm.
METHODS: A literature review was performed for articles related to telemedicine. We used PubMed, Google Scholar, Cochrane Library, and Ovid MEDLINE to search published articles. We used the following keywords: “Telemedicine,” “diabetes mellitus,” “COVID-19,” “diabetic foot ulcer,” and “remote monitoring.”
RESULTS: Implementation of the proposed pandemic care includes telemedicine for remote monitoring and treatment of patients with diabetic foot ulcers, as well as an algorithm for determining the risk of diabetic ulcer infection and patient management tactics according to the identified risk.
CONCLUSION: The management of patients with diabetic foot ulcers during a pandemic includes the following goals – to reduce the burden on the health-care system, maintain the safety and functionality of diabetic foot at home, and reduce the risk of COVID-19 in patients with diabetic foot ulcers.
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Economic Evaluation of Sucrose Octasulfate Dressing for the Treatment of Diabetic Foot Ulcers for Type 2 Diabetes Patients. Can J Diabetes 2021; 46:126-133. [DOI: 10.1016/j.jcjd.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/05/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022]
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Mariet AS, Benzenine E, Bouillet B, Vergès B, Quantin C, Petit JM. Impact of the COVID-19 Epidemic on hospitalization for diabetic foot ulcers during lockdown: A French nationwide population-based study. Diabet Med 2021; 38:e14577. [PMID: 33797791 DOI: 10.1111/dme.14577] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the impact of the COVID-19 epidemic on the hospitalization rates for diabetic foot ulcer (DFU), osteomyelitis and lower limb revascularization procedure in people with DFU. METHODS This nationwide retrospective cohort study included hospital data on all people hospitalized in France for diabetes in weeks 2-43 in 2020, including the COVID-19 lockdown period, compared to same period in 2019. RESULTS The number of hospitalizations for DFU decreased significantly in weeks 12-19 (during the lockdown) (p < 10-4 ). Hospitalization for foot osteomyelitis also decreased significantly in weeks 12-19 (p < 10-4 ). The trend was the same for lower limb amputations and revascularizations associated with DFU or amputation. CONCLUSIONS/INTERPRETATION The marked drop in hospitalization rates for DFU, osteomyelitis and lower limb revascularization procedures in people with DFU observed in France during the lockdown period suggests that COVID-19 was a barrier to DFU care, and may illustrate the combined deleterious effects of hospital overload and changes in health-related behaviour.
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Affiliation(s)
- Anne-Sophie Mariet
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France
- INSERM, CIC 1432, Dijon, France
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France
- INSERM, CIC 1432, Dijon, France
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France
| | - Benjamin Bouillet
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, Dijon, France
| | - Bruno Vergès
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France
- INSERM, CIC 1432, Dijon, France
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France
| | - Jean-Michel Petit
- INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, Dijon, France
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Ai-Jalodi O, Sabo M, Patel K, Bullock N, Serena L, Breisinger K, Serena TE. Efficacy and safety of a porcine peritoneum-derived matrix in diabetic foot ulcer treatment: a pilot study. J Wound Care 2021; 30:S18-S23. [PMID: 33573495 DOI: 10.12968/jowc.2021.30.sup2.s18] [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: 01/09/2023]
Abstract
OBJECTIVE A third of people with diabetes will develop a foot ulcer during their lifetime. The absence of pain secondary to neuropathy often leads to a delay in diagnosis and treatment. Diabetic foot ulcer (DFU) complications, such as infection and amputation, increase mortality and strain the financial resources of health systems across the world. Cellular and/or tissue products (CTPs) have played an important role in the closure of DFUs. Investigators continue to search for new CTPs that facilitate healing. The aim of this study was to assess the efficacy and safety of a porcine peritoneum-derived matrix in DFU treatment. METHOD Patients with longstanding DFUs participated in this institutional review board-approved, multicentre, prospective pilot study evaluating the time to healing over 12 weeks. In addition to weekly assessments for wound size, investigators analysed bacterial burden using the MolecuLight procedure (MLiX) and bacterial protease (BPA) testing. Participants received a weekly application of Meso Wound Matrix Scaffold (MWM), a lyophilised porcine peritoneum-derived matrix (DSM Biomedical Inc., Exton, PA, US) for up to eight weeks. Descriptive statistics were chosen for this analysis. RESULTS A total of 12 male patients and three female patients with an average age of 57 years were enrolled over a two-month period. The average wound duration was 30 weeks. Due to unrelated health issues, four participants were withdrawn. For the study endpoint of complete wound closure at 12 weeks, six (55%) of the remaining 11 patients achieved complete closure, and four (36%) patients healed during the 8-week treatment period. The average number of CTP applications was six. Patients who healed all had negative BPA by nine weeks and no fluorescence on MLiX, indicating low bacterial load. CONCLUSION This small pilot study indicates that patients with longstanding DFUs may respond to a porcine peritoneal-derived CTP. In this study, the CTP appears to have inhibited bacterial growth in the wound; however, further research is needed.
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Affiliation(s)
| | - Matthew Sabo
- Foot and Ankle Wellness Center, Ford City, PA, US
| | | | | | - Laura Serena
- SerenaGroup Research Foundation, Cambridge, MA, US
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40
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Manning L, Ferreira IB, Gittings P, Hiew J, Ryan E, Baba M, Raby E, Carville K, Norman PE, Davis WA, Wood F, Hamilton EJ, Ritter JC. Wound healing with "spray-on" autologous skin grafting (ReCell) compared with standard care in patients with large diabetes-related foot wounds: an open-label randomised controlled trial. Int Wound J 2021; 19:470-481. [PMID: 34156758 PMCID: PMC8874115 DOI: 10.1111/iwj.13646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 01/26/2023] Open
Abstract
There is an urgent need for interventions that improve healing time, prevent amputations and recurrent ulceration in patients with diabetes‐related foot wounds. In this randomised, open‐label trial, participants were randomised to receive an application of non‐cultured autologous skin cells (“spray‐on” skin; ReCell) or standard care interventions for large (>6 cm2), adequately vascularised wounds. The primary outcome was complete healing at 6 months, determined by assessors blinded to the intervention. Forty‐nine eligible foot wounds in 45 participants were randomised. An evaluable primary outcome was available for all wounds. The median (interquartile range) wound area at baseline was 11.4 (8.8‐17.6) cm2. A total of 32 (65.3%) index wounds were completely healed at 6 months, including 16 of 24 (66.7%) in the spray‐on skin group and 16 of 25 (64.0%) in the standard care group (unadjusted OR [95% CI]: 1.13 (0.35‐3.65), P = .845). Lower body mass index (P = .002) and non‐plantar wounds (P = .009) were the only patient‐ or wound‐related factors associated with complete healing at 6 months. Spray‐on skin resulted in high rates of complete healing at 6 months in patients with large diabetes‐related foot wounds, but was not significantly better than standard care (Australian New Zealand Clinical Trials Registry: ACTRN12618000511235).
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Affiliation(s)
- Laurens Manning
- Harry Perkins Research Institute, Fiona Stanley Hospital, Medical School, University of Western Australia, Murdoch, Western Australia, Australia.,Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Ivana Bastos Ferreira
- Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Podiatry, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Paul Gittings
- Department of Burns, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jonathan Hiew
- Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Podiatry, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Erica Ryan
- Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Podiatry, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mendel Baba
- Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Podiatry, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Edward Raby
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Burns, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Keryln Carville
- Silver Chain Group and Curtin University, Wilson, Western Australia, Australia
| | - Paul E Norman
- Harry Perkins Research Institute, Fiona Stanley Hospital, Medical School, University of Western Australia, Murdoch, Western Australia, Australia.,Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Vascular Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Wendy Angela Davis
- Medical School, Fremantle Hospital, University of Western Australia, Fremantle, Western Australia, Australia
| | - Fiona Wood
- Department of Burns, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Emma Jane Hamilton
- Harry Perkins Research Institute, Fiona Stanley Hospital, Medical School, University of Western Australia, Murdoch, Western Australia, Australia.,Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Endocrinology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jens Carsten Ritter
- Multidisciplinary Diabetes Foot Ulcer Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Medical School, Fremantle Hospital, University of Western Australia, Fremantle, Western Australia, Australia.,Medical School, Curtin University, Perth, Western Australia, Australia
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41
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Serena TE, Bayliff SW, Brosnan PJ, DiMarco DT, Doner BA, Guthrie DA, Patel KD, Sabo MJ, Samies JH, Carter MJ. Bacterial protease activity as a biomarker to assess the risk of non-healing in chronic wounds: Results from a multicentre randomised controlled clinical trial. Wound Repair Regen 2021; 29:752-758. [PMID: 34057796 DOI: 10.1111/wrr.12941] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
Millions worldwide suffer from chronic wounds challenging clinicians and burdening healthcare systems. Bacteria impede wound healing; however, the diagnosis of excessive bacterial burden or infection is elusive. Clinical signs and symptoms of infection are inaccurate and unreliable. This trial evaluated a novel, point-of-care, lateral flow diagnostic designed to detect virulence factors released by the most common bacteria found in chronic wounds. A multicentre prospective cohort clinical trial examined the efficacy of a diagnostic test in detecting bacterial proteases taken from swab samples of chronic venous, arterial, pressure and mixed aetiology chronic wounds. Two hundred and sixty six wounds were included in the analysis of the study. The wounds were tested at the start of the study after which investigators were permitted to use whatever dressings they desired for the next 12 weeks. Healing status at 12 weeks was assessed. The presence of elevated bacterial protease activity decreased the probability of wound healing at 12 weeks. In contrast, a greater proportion of wounds were healed at 12 weeks if they had little or no bacterial protease activity at study start. In addition, the presence of elevated bacterial protease activity increased the time it takes for a wound to heal and increased the risk that a wound would not heal, when compared to the absence of bacterial protease activity. The results of this clinical trial indicate that bacterial protease activity, as detected by this novel diagnostic test, is a valid clinical marker for chronicity in wounds. The diagnostic test offers a tool for clinicians to detect clinically significant bacteria in real time and manage bacteria load before the clinical signs and symptoms of infection are evident.
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Affiliation(s)
- Thomas E Serena
- SerenaGroup Research Foundation, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | - Matthew J Sabo
- Foot and Ankle Wellness Center of Western PA, Ford City, Pennsylvania, USA
| | - John H Samies
- Palmetto Infectious Disease, Columbia, South Carolina, USA
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Hamed S, Ullmann Y, Belokopytov M, Shoufani A, Kabha H, Masri S, Feldbrin Z, Kogan L, Kruchevsky D, Najjar R, Liu PY, Kerihuel JC, Akita S, Teot L. Topical Erythropoietin Accelerates Wound Closure in Patients with Diabetic Foot Ulcers: A Prospective, Multicenter, Single-Blind, Randomized, Controlled Trial. Rejuvenation Res 2021; 24:251-261. [PMID: 33504262 DOI: 10.1089/rej.2020.2397] [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] [Indexed: 01/13/2023] Open
Abstract
The diabetic foot ulcer (DFU) is a major disabling complication of diabetes mellitus. Growing evidence suggests that topical erythropoietin (EPO) can promote wound healing. The aim of this study is to clinically assess the efficacy of a proprietary topical EPO-containing hydrogel for treating DFUs. We conducted a randomized, controlled trial in 20 patients with DFUs. After a 14-day screening period, the DFUs of 20 eligible participants who fulfilled the inclusion criteria were randomly assigned (1:1) to either a 12-week of daily treatment with topical EPO and standard-of-care (SOC) or SOC treatment alone. The DFUs were assessed weekly until week 12. The primary outcome was 75% ulcer closure or higher. After 12 weeks of treatment, 75% ulcer closure was achieved in 6 of the 10 patients whose DFUs were treated with topical EPO and in one of the 8 patients whose DFUs were treated with SOC alone. The mean area of the DFUs that were treated with topical EPO and SOC was significantly smaller than those treated with SOC alone (1.2 ± 1.4 cm2 vs. 4.2 ± 3.4 cm2; p = 0.023). Re-epithelialization was faster in the topically EPO-treated DFUs than in the SOC-treated DFUs. There were no treatment-related adverse events. We conclude that topical EPO is a promising treatment for promoting the healing of DFUs. Clinical Trial Registration number: NCT02361931.
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Affiliation(s)
- Saher Hamed
- Department of Research and Development, Remedor Biomed Ltd., Nazareth Illit, Israel
| | - Yehuda Ullmann
- Department of Plastic and Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Mark Belokopytov
- Department of Research and Development, Remedor Biomed Ltd., Nazareth Illit, Israel
| | - Aziz Shoufani
- Department of Plastic Surgery and General Surgery, Emek Medical Center, Afula, Israel
| | - Hoda Kabha
- Department of Research and Development, Remedor Biomed Ltd., Nazareth Illit, Israel
| | - Suher Masri
- Department of Research and Development, Remedor Biomed Ltd., Nazareth Illit, Israel
| | - Zeev Feldbrin
- Diabetes Foot Care Unit, Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Kogan
- Department of Plastic Surgery, Western Galilee Medical Center, Nahariya, Israel
| | - Danny Kruchevsky
- Department of Plastic and Reconstructive Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Roger Najjar
- Department of Plastic Surgery, Western Galilee Medical Center, Nahariya, Israel
| | - Paul Y Liu
- Department of Plastic Surgery, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Sadanori Akita
- Department Wound Care and Plastic and Reconstructive Surgery, Fukuoka University, Fukuoka, Japan
| | - Luc Teot
- Department of Plastic and Reconstructive Surgery and Wound Healing, Montpellier University Hospital, Lapeyronie, Montpellier, France
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Meloni M, Acquati S, Licciardello C, Ludovico O, Sepe M, Vermigli C, Da Ros R. Barriers to diabetic foot management in Italy: A multicentre survey in diabetic foot centres of the Diabetic Foot Study Group of the Italian Society of Diabetes (SID) and Association of Medical Diabetologists (AMD). Nutr Metab Cardiovasc Dis 2021; 31:776-781. [PMID: 33549455 DOI: 10.1016/j.numecd.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Diabetic foot (DF) disease is a current health and social burden. The authors aimed to identify the barriers to the DF management across Italy. METHODS AND RESULTS A questionnaire was submitted to Italian centres dedicated to DF care. The questionnaire was composed of 12 questions focused on the barriers to the DF management including timing of referral, hospital management, and community follow-up. Each centre could answer by choosing a score from 1 to 5 for every item with the following numerical variables: 1 = never; 2 = rarely; 3 = sometimes; 4 = often; 5 = always. Accordingly, for each item a national and regional score was reported and a comparison between regions was carried out. National and regional scores were estimated using the total score for each item as a numerator and the number of national centres included as a denominator. Among 102 centres, 99 were included and 3 were excluded due to missing data. The 99 centres belonged to 16 regions with the following distribution: Calabria 4, Campania 5, Emilia-Romagna 14, Friuli-Venezia-Giulia 4, Lazio 12, Liguria 4, Lombardy 10, Marche 1, Molise 1, Piedmont 5, Apulia 5, Sardinia 5, Sicily 4, Tuscany 11, Veneto 9, Umbria 5. The items with the highest score were late referral (3.3) and urgent surgery (3.2). The regions with the highest score were Molise (3.9) and Calabria (3.5). CONCLUSION The main issues across Italy were late referral and the requirement for urgent surgery for acute DF. In the regional scenario, the southern central areas showed more barriers than northern regions.
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Affiliation(s)
- Marco Meloni
- Diabetic Foot Unit, Department of Systems Medicine, University of Rome Tor Vergata, Italy.
| | - Silvia Acquati
- Unit of Endocrinology, Pierantoni-Morgagni Hospital, Forlì AUSL Romagna, Italy
| | - Carmelo Licciardello
- UFC Malattie disendocrine e dismetaboliche, Centro Catanese di Medicina e Chirurgia, Catania, Italy
| | - Ornella Ludovico
- Unit of Endocrinology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Cristiana Vermigli
- Unit of Endocrinology, Diabetic Foot Centre, University Hospital Santa Maria della Misericordia, Perugia, Italy
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44
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Meloni M, Bouillet B, Ahluwalia R, Lüdemann C, Sánchez‐Ríos JP, Iacopi E, Lazaro‐Martinez JL. Fast-track pathway for diabetic foot ulceration during COVID-19 crisis: A document from International Diabetic Foot Care Group and D-Foot International. Diabetes Metab Res Rev 2021; 37:e3396. [PMID: 32804425 PMCID: PMC7460948 DOI: 10.1002/dmrr.3396] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/07/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Marco Meloni
- Diabetic Foot CenterUniversity of Tor VergataRomeItaly
| | | | - Raju Ahluwalia
- Department of Trauma and Ortophaedic DepartmentKing's College HospitalLondonUK
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45
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Telemedicine in the Wake of the COVID-19 Pandemic: Increasing Access to Surgical Care. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 9:e3228. [PMID: 33564566 PMCID: PMC7858711 DOI: 10.1097/gox.0000000000003228] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 01/16/2023]
Abstract
The COVID-19 pandemic has brought seismic shifts in healthcare delivery. The objective of this study was to examine the impact of telemedicine in the disadvantaged population.
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46
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Patry J, Tourigny A, Mercier MP, Dionne CE. Outcomes and prognosis of diabetic foot ulcers treated by an interdisciplinary team in Canada. Int Wound J 2020; 18:134-146. [PMID: 33236835 PMCID: PMC8244008 DOI: 10.1111/iwj.13505] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to determine the wound healing outcomes of patients with a plantar diabetic foot ulcer (DFU) treated with an interdisciplinary team approach, and to identify associated variables. A retrospective observational cohort study of 140 adult patients, with a plantar DFU, treated between 2012 and 2018 at a wound care clinic of a University affiliated hospital was conducted. Predictive and explicative analyses were conducted with logistic multivariate methods and with a Receiver Operating Characteristics curve. The best predictor of wound healing at 3 months was a 41.8% wound size reduction at 4 weeks (AUC: 0.86; sensitivity: 83.1%; specificity: 67.2%, positive predictive value: 72.8%; negative predictive value: 78.9%; positive and negative likelihood ratios: 2.53 and 0.25, respectively). Main baseline variables independently associated with this predictor were: a monophasic Doppler waveform (OR 7.52, 95% CI [2.64–21.39]), cigarette smoking (OR 4.7, 95% CI [1.44–15.29]), and male gender (OR 3.58, 95% CI [1.30–9.87]). The health care provider should be cautious and intensify its management of DFUs particularly with patients of male gender; smoking, having a monophasic waveform with a hand‐held Doppler, and not achieving a minimal 41.8% wound area reduction at 4 weeks of treatment.
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Affiliation(s)
- Jérôme Patry
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada.,Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval. Hôpital du Saint-Sacrement, Québec, Québec, Canada.,Department of Physical Activity Sciences, Podiatric Medicine Program, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - André Tourigny
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval. Hôpital du Saint-Sacrement, Québec, Québec, Canada
| | - Marie-Philippe Mercier
- Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Québec, Canada.,Department of Physical Activity Sciences, Podiatric Medicine Program, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Clermont E Dionne
- Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Québec, Canada.,Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval. Hôpital du Saint-Sacrement, Québec, Québec, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Québec, Canada
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47
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Barnwal S, Kant R, Yadav P. Autologous non-cultured keratinocyte cell suspension in non-healing diabetic ulcers: A preliminary study. J Family Med Prim Care 2020; 9:4686-4691. [PMID: 33209784 PMCID: PMC7652156 DOI: 10.4103/jfmpc.jfmpc_627_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/10/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Diabetic ulcers are a common morbidity associated with poorly controlled glycemic status. Most patients often have neuropathy and vasculopathy as the etiology behind such ulcers. These factors not only lead to poor wound healing but also nonhealing ulcers. Nonhealing ulcers pose therapeutic challenges as they are usually not amenable to be treated with simple wound care and hence require newer modalities to effectively cure this condition that leads to a plethora of poor health outcomes. This study was conducted to see the effect of autologous noncultured keratinocyte cell suspension in chronic nonhealing diabetic ulcers that failed to normal wound care. Material and Methods: It was an observational pilot study. A total of 05 patients with nonhealing ulcers, attending the tertiary care teaching hospital in North India, were included in the study. Inclusion criteria was type 2 DM with more than 5 years duration of diabetes mellitus and glycated hemoglobin (HbA1c) <9 g%. History was taken in detail; name, age, sex, address, duration of disease and various other treatments taken from outside were noted; and size of ulcer was recorded as per Proforma. Results: A total of 5 patients were enrolled in the study, three (60%) and two (40%) patients were male and female, respectively. Three (60%) patients were habitual for tobacco use. Mean age of patients was 45 ± 6.51 years. Mean duration of ulcers was 4.8 ± 1.48 months. Area of ulcers ranged from 31.2 to 122.2 cm2. Majority of cases, three (60%) of diabetic foot ulcers, were improved at 9–12 weeks and remaining two cases with large size of ulcer were healed at 13–16 weeks and 17–20 weeks, respectively. Majority (80%) of patients revealed >50% reduction in the size of ulcer within 2 weeks. Conclusion: Noncultured keratinocytes are useful in healing of nonhealing diabetic ulcer.
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Affiliation(s)
- Shruti Barnwal
- Department of Dermatology, Govt. Doon Medical College, Dehradun, Uttarakhand, India
| | - Ravi Kant
- Department of Medicine, Division of Diabetes and Metabolism, AIIMS, Rishikesh, Uttarakhand, India
| | - Poonam Yadav
- College of Nursing, AIIMS, Rishikesh, Uttarakhand, India
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48
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Abu-Qamar MZ, Kemp V, Whitehead L. Foot ulcers associated with external trauma among people with diabetes: An integrative review of the origin of trauma and outcomes. Int J Nurs Stud 2020; 114:103822. [PMID: 33248292 DOI: 10.1016/j.ijnurstu.2020.103822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Foot ulcers are common among people with diabetes. These ulcers are caused by a number of factors including trauma. To date, research findings on the origin of external trauma and the outcome of foot ulcers resulting from an external trauma have not been summarised. OBJECTIVE To examine the origin of external trauma that contribute to the development of foot ulcers among people with diabetes and the outcome of such ulcers. DESIGN An integrative review. SETTINGS Hospital/community. PARTICIPANTS Patients with diabetes and foot ulcer. METHOD The Joanna Briggs framework was used to underpin this integrative review. Six different databases (CINAHL +, Medline, SCOPUS, Embase, ProQuest and Web of Science databases) were searched systematically to find research publications reporting traumas that contributed to foot ulcers sustained by people with diabetes. The search was limited to articles published in English. The search revealed 3193 articles that were filtered to 78 articles to be assessed at the full-text level and 45 articles were subsequently included. Quality appraisal was conducted independently by two reviewers, using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Data were extracted into a form developed for the purpose of this review. Narrative synthesis was used to manage the extracted verbatim details on the origin of external trauma contributing to foot ulcers and the outcomes. RESULTS The origins of external trauma were summarised into two domains and further specified into 16 categories. The identified traumas were mainly minor and originated within the home environment. The most commonly reported origins of external trauma were puncture wounds, ill-fitting shoes and self-care practices that caused foot ulcers. Twenty-seven studies reported outcomes following the development of an ulcer. Twenty-two studies reported amputation as an outcome and mortality was reported in 10 studies. It was not clear whether these outcomes were directly related to the foot ulcer or related to other diabetes-related complications. CONCLUSIONS The majority of ulcers occurred in the home environment and were preventable in nature. The assessment of an individual's local context, particularly the home and actions to reduce risk is a priority. The extent of the risks related to external trauma need to be more widely communicated through clinical guidelines and training opportunities for frontline staff. TWEETABLE ABSTRACT The main origins of external foot trauma among people with diabetes were puncture wounds, ill-fitting footwear and self-care practices.
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Affiliation(s)
- Ma'en Zaid Abu-Qamar
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia; Department of Adult Health Nursing, Faculty of Nursing, Mu´tah University, Mu´tah, Jordan.
| | - Vivien Kemp
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
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49
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Iversen MM, Igland J, Smith-Strøm H, Østbye T, Tell GS, Skeie S, Cooper JG, Peyrot M, Graue M. Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: secondary outcomes from a cluster randomized controlled trial (DiaFOTo). BMC Endocr Disord 2020; 20:157. [PMID: 33087074 PMCID: PMC7580005 DOI: 10.1186/s12902-020-00637-x] [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: 05/04/2020] [Accepted: 10/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. METHODS The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer-Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. RESULTS In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. CONCLUSIONS There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants' health, well-being and quality of life. TRIAL REGISTRATION Clinicaltrials.gov , NCT01710774 . Registered October 19th, 2012.
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Affiliation(s)
- Marjolein M Iversen
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway.
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
| | - Jannicke Igland
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hilde Smith-Strøm
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Truls Østbye
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svein Skeie
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - John G Cooper
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Mark Peyrot
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA
| | - Marit Graue
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
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50
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Lobmann R, Grünerbel A, Lawall H, Lüdemann C, Morbach S, Tigges W, Völkel L, Rychlik RP. Impact of wound duration on diabetic foot ulcer healing: evaluation of a new sucrose octasulfate wound dressing. J Wound Care 2020; 29:543-551. [PMID: 33052796 DOI: 10.12968/jowc.2020.29.10.543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE A common and frequent complication of diabetes is diabetic foot ulcers (DFU), which can have high treatment costs and severe adverse events. This study aims to evaluate the effects of wound duration on wound healing and the impact on costs, including treatment with a new sucrose octasulfate dressing compared with a control dressing. METHOD Based on the Explorer study (a two-armed randomised double-blind clinical trial), a cost-effectiveness analysis compared four different patient groups distinguished by their wound duration and additionally two DFU treatment options: a sucrose octasulfate dressing and a neutral dressing (as control). Clinical outcomes and total direct costs of wound dressings were evaluated over 20 weeks from the perspective of the Social Health Insurance in Germany. Simulation of long-term outcomes and costs were demonstrated by a five cycle Markov model. RESULTS The results show total wound healing rates between 71% and 14.8%, and direct treatment costs for DFU in the range of €2482-3278 (sucrose octasulfate dressing) and €2768-3194 (control dressing). Patients with a wound duration of ≤2 months revealed the highest wound healing rates for both the sucrose octasulfate dressing and control dressing (71% and 41%, respectively) and had the lowest direct treatment costs of €2482 and €2768, respectively. The 100-week Markov model amplified the results. Patients with ≤2 months' wound duration achieved wound healing rates of 98% and 88%, respectively and costs of €3450 and €6054, respectively (CE=€3520, €6864). Sensitivity analysis revealed that the dressing changes per week were the most significant uncertainty factor. CONCLUSION Based on the findings of this study, early treatment of DFU with a sucrose octasulfate dressing is recommended from a health economic view due to lower treatment costs, greater cost-effectiveness and higher wound healing rates.
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Affiliation(s)
- Ralf Lobmann
- Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Stuttgart
| | | | - Holger Lawall
- Gemeinschaftspraxis Prof. Dr. med. Curt Diehm, Dr. med. Holger Lawall, Ettlingen
| | - Claas Lüdemann
- Evangelisches Waldkrankenhaus Spandau, Ein Unternehmen der Paul Gerhardt Diakonie, Berlin
| | | | | | - Lukas Völkel
- Institute of Empirical Health Economics, Burscheid, Germany
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