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Ferreira G, Carvalho A, Pereira MG. Educational Interventions on Diabetic Foot Self-Care: A Study Protocol for a Pragmatic Randomized Controlled Trial. HEALTH COMMUNICATION 2024; 39:1383-1392. [PMID: 37204003 DOI: 10.1080/10410236.2023.2213875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Diabetic foot is one of the most serious complications of diabetes and foot ulcer recurrence has been associated with poor foot care. Educational programs may work as a vehicle for promoting knowledge and adequate foot self-care behaviors, reducing potential ulcerative complications in the diabetic foot, and promoting a better quality of life. This study protocol will analyze the impact of two different educational strategies - an instructive video (Experimental Group 1) compared to a foot care leaflet with real-time guided reading (Experimental Group 2) and standard care (Control Group) - on adherence and knowledge about diabetic foot care and patients' perception of their foot health. This study is a Pragmatic Randomized Controlled Trial of a non-pharmacological treatment. Participants need to have a diabetic foot diagnosis and attend a Diabetic Foot Multidisciplinary Consultation at two hospitals from the North of Portugal. Participants will be assessed at the first appointment of the diabetic foot consultation (T0), two weeks after (T1), and three months later, at follow-up (T2). Primary outcomes will be adherence and knowledge about diabetic foot care and general foot health. Secondary outcomes will be illness representations regarding diabetic foot. The results of this study will inform educational interventions to decrease diabetic foot ulcers, amputation rates, and the costs associated with both, contributing to foot care adherence and improve patient's quality of life.
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Affiliation(s)
- Gabriela Ferreira
- Psychology Research Centre, School of Psychology, University of Minho
| | - André Carvalho
- Service of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto
| | - M Graça Pereira
- Psychology Research Centre, School of Psychology, University of Minho
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Ullas A, Adhikari Mr P, Leena KC, Sasikumar S. Understanding the Dynamic Relationship of Diabetes Distress and Glycemic Indicators in Foot Ulcer Patients: A Correlative Study. Cureus 2024; 16:e57328. [PMID: 38690484 PMCID: PMC11060392 DOI: 10.7759/cureus.57328] [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: 03/11/2024] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Diabetes-related distress and glycemic indicators are the most common concerns for patients with diabetes mellitus and have a major impact on diabetic patients' lifestyle, mental well-being, and healthcare access. The principal aim of research in this field is to ascertain the correlation between distress associated with diabetes and glycemic indicators. this helps in developing interventions that can enhance the overall physical and mental well-being of individuals with diabetes. OBJECTIVE The objective is to assess the diabetes distress and glycemic indicators among patients with foot ulcers and to find the correlation between diabetes distress and glycemic parameters. MATERIALS AND METHODS A descriptive correlational study was conducted among 159 patients with foot ulcers who were admitted to the hospital by using a non-probability purposive sampling method. The severity of diabetes distress was evaluated utilizing the four-subscale Diabetes Distress Scale (DDS-17). Glycemic indicators are calculated through the assessment of random blood sugar, fasting blood sugar (FBS), and glycosylated hemoglobin (HbA1c). RESULT The study revealed that most participants were above 60 years old and were male. Of the samples, 52% had moderate distress. All the subscales of diabetes distress are correlated to the overall DDS score. A negative correlation (r= -0.162, p < 0.041) was found between emotional burden and FBS which was statistically significant, whereas FBS is positively related to HbA1c (r=0.194, p=0.015). CONCLUSION The significant correlation between DDS scores, the subscales of diabetes distress, and glycemic indicators highlights the criticality of incorporating diabetes distress management into comprehensive strategies for managing diabetes. Moreover, the research underscores the necessity of employing multidisciplinary strategies when attending to diabetic patients to prevent complications.
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Affiliation(s)
- Anju Ullas
- Department of Medical Surgical Nursing, Yenepoya Nursing College, Yenepoya (Deemed to be University), Mangaluru, IND
| | - Prabha Adhikari Mr
- Department of Geriatric Medicine, Yenepoya Medical College Hospital, Yenepoya (Deemed to be University), Mangaluru, IND
| | - K C Leena
- Department of Community Health Nursing, Yenepoya Nursing College, Yenepoya (Deemed to be University), Mangaluru, IND
| | - S Sasikumar
- Department of Medical Surgical Nursing, Father Muller College of Nursing, Mangaluru, IND
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Darwis P, Syaifudin A, Suhartono R, Muradi A, Pratama D, Dewi DK, Hamzah A. Associations Between Systolic Pressure, Vascular Waveform, and Volume Flow with Debridement or Amputation Treatment Decisions in Diabetic Foot Ulcer Patients. INT J LOW EXTR WOUND 2024:15347346241233364. [PMID: 38389316 DOI: 10.1177/15347346241233364] [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: 02/24/2024]
Abstract
INTRODUCTION Diabetic foot ulcer disease, affecting 6.3% of the global population, necessitates crucial decisions regarding debridement and amputation, with substantial cost, morbidity, and mortality implications. This study's primary goal is to determine effective vascular examination modalities, including systolic blood pressure, vascular waveforms, and blood volume flow to guide optimal treatments for diabetic foot patients. METHOD This cross-sectional study at Cipto Mangunkusumo General Hospital aimed to identify effective vascular examination modalities, such as systolic blood pressure, vascular waveforms, and blood volume flow, to guide treatment choices for diabetic foot patients. The study included 38 subjects, equally split between debridement and amputation groups. RESULTS Notably, the presence of a biphasic pattern in popliteal artery vascular examinations was associated with the decision for amputation in diabetic foot patients (p < 0.05). The Chi-square test revealed that a biphasic ultrasound pattern served as a predictive factor for amputation among diabetic foot patients, with three times more biphasic patients choosing amputation over debridement. Conversely, assessments of popliteal artery systolic pressure, common femoral artery waveform, popliteal artery volume flow, and common femoral artery volume flow showed no significant correlations with the choice of debridement or amputation treatment for diabetic foot patients. CONCLUSION In summary, ultrasound assessment of vascular waveform in the popliteal artery emerges as a predictive factor for amputation or debridement in diabetic foot patients.
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Affiliation(s)
- Patrianef Darwis
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ahmad Syaifudin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Raden Suhartono
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Akhmadu Muradi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dedy Pratama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dian Kusuma Dewi
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Alif Hamzah
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Seo H, Yoon J, Cho OH. Falls, fear of falling, and related factors in patients with diabetic foot disease. Appl Nurs Res 2023; 73:151715. [PMID: 37722783 DOI: 10.1016/j.apnr.2023.151715] [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: 09/12/2022] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Falls and fear of falling (FOF) are common in patients with diabetic foot disease (DFD). PURPOSE To understand the relationship between falls, FOF, and related factors in patients with DFD. METHOD We recruited 70 patients being treated for DFD at two hospitals in Korea. A structured questionnaire was used in investigating fall experience, FOF, and related factors. RESULTS Among the participants, 42.8 % fell in the past year, and FOF was reported in 57.1 %. Rates of "no caregiver," "DFD duration (>1 year)," and "burning pain" were higher in fallers than non-fallers. The rates of "older adults (≥65 years of age)," "unemployed," "not using assistive devices," "visual impairment," and "hearing impairment" were higher in patients with FOF than in those without FOF. However, the level of balance confidence was lower in patients with FOF. CONCLUSIONS The fall experience of patients with DFD was associated with the presence of their caregiver, disease-related factors, and foot pain symptoms, while FOF was related to age and fall-related factors.
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Affiliation(s)
- Hyerim Seo
- Department of Nursing, Chungnam National University Sejong Hospital, Sejong, Republic of Korea.
| | - Jeongeun Yoon
- Department of Nursing, Kunsan College of Nursing, Gunsan, Republic of Korea
| | - Ok-Hee Cho
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea.
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Calabrese L, Maffoni M, Torlaschi V, Pierobon A. What Is Hidden behind Amputation? Quanti-Qualitative Systematic Review on Psychological Adjustment and Quality of Life in Lower Limb Amputees for Non-Traumatic Reasons. Healthcare (Basel) 2023; 11:healthcare11111661. [PMID: 37297801 DOI: 10.3390/healthcare11111661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE This systematic review aims to investigate Quality of Life (QoL)/Health Related Quality of Life (HRQoL) and psychological adjustment in non-traumatic lower limb amputees (LLA). METHODS PubMed, Scopus, and Web of Science databases were used for the literature search. Studies were read and analysed using the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA statement procedure. RESULTS The literature search retrieved 1268 studies, of which 52 were included in the systematic review. Overall, psychological adjustment, especially depression with or without anxiety symptoms, influences the QoL/HRQoL in this clinical population. Other factors influencing QoL/HRQoL include subjective characteristics, physical aspects, the cause and level of the amputation, relational aspects, social support, and the doctor-patient relationship. In addition, the patient's emotional-motivational status, depression and/or anxiety symptoms, and acceptance play a key role in the subsequent rehabilitation process. CONCLUSIONS In LLA patients, psychological adjustment is a complex and multifaceted process, and QoL/HRQoL may be influenced by various factors. Shedding light on these issues may provide useful suggestions for promoting clinical and rehabilitative interventions that may be tailored and effective in this clinical population.
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Affiliation(s)
- Laura Calabrese
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute, 27040 Montescano, Italy
| | - Marina Maffoni
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute, 27040 Montescano, Italy
| | - Valeria Torlaschi
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute, 27040 Montescano, Italy
| | - Antonia Pierobon
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Montescano Institute, 27040 Montescano, Italy
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Pereira MG, Pedras S, Louro A, Lopes A, Vilaça M. Stress reduction interventions for patients with chronic diabetic foot ulcers: a qualitative study into patients and caregivers' perceptions. J Foot Ankle Res 2023; 16:3. [PMID: 36747299 PMCID: PMC9901134 DOI: 10.1186/s13047-022-00592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/24/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The present study aimed to assess the perceptions of patients with chronic diabetic foot ulcers (DFUs) and their family caregivers regarding the impact of two stress reduction interventions on DFU and psychological wellbeing. The intervention included progressive muscle relaxation and hypnosis sessions. METHODS This study used a qualitative exploratory design and included individual interviews with eight patients with chronic DFUs and six family caregivers, using a semi-structured interview guide. Transcript analysis employed thematic content analysis. RESULTS Four key themes common to patients and their caregivers were found: 1) perspectives regarding the intervention; 2) intervention effectiveness; 3) perceived importance of psychology in the DFU treatment; and 4) emotional consequences associated with DFUs. Although themes were common to both intervention groups, sub-themes from the last two themes differed for patients that received muscle relaxation versus those who received hypnosis. CONCLUSION Patients and caregivers reported perceived benefits from both interventions, regarding DFU healing and emotional wellbeing. Patients who received hypnosis and their caregivers also reported lasting effects. Participants suggested that psychological interventions such as stress reduction interventions could be included in the DFU standard treatment as an adjuvant to the clinical protocol for DFU treatment, preferably offered early on, when patients begin treatment at the diabetic foot consultation.
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Affiliation(s)
- M. Graça Pereira
- grid.10328.380000 0001 2159 175XPsychology Research Centre (CIPsi), University of Minho, Braga, Portugal ,grid.10328.380000 0001 2159 175XSchool of Psychology, Department of Applied Psychology, University of Minho, Campus de Gualtar, Braga, 4710-057 Portugal
| | - Susana Pedras
- grid.5808.50000 0001 1503 7226Angiology & Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUP), Porto, Portugal
| | - André Louro
- grid.10328.380000 0001 2159 175XHealth & Family Research Group, Psychology Research Centre (CIPsi), University of Minho, Braga, Portugal
| | - Alberto Lopes
- Portuguese Association of Clinical Hypnosis and Hypnoanalysis (APHCH), Porto, Portugal
| | - Margarida Vilaça
- grid.10328.380000 0001 2159 175XPsychology Research Centre (CIPsi), University of Minho, Braga, Portugal
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Alfalki AM, Muhseen ZT. Sociodemographic and Diabetes-related Risk Factors in San Diego County, California. Curr Diabetes Rev 2023; 19:71-79. [PMID: 35184714 DOI: 10.2174/1573399818666220218092646] [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: 10/25/2021] [Revised: 12/09/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The research information would enable clinicians and public health professionals to formulate proper interventions for diabetic people according to age, gender, and race. OBJECTIVE The aim of the study was to investigate the relationship between diabetes-related mortality, hospitalization and emergency department discharge, and sociodemographic characteristics, in addition to age-standardized mortality rate analysis. METHOD A population-based cross-sectional descriptive study was carried out to determine the relationship between sociodemographic characteristics and diabetes-related risk factors of the San Diego County residents in 2018, including 49,283 individuals (27,366 males and 21,917 females). RESULTS The outcomes were found to be statistically significant. Hospitalization and emergency department discharges among males and females were statistically significant. The statistical differences between gender and mortality were not significant. The mortality was not significant in the male group, while it was statistically significant in the female group. The noted agestandardized mortality rate of diabetes stood at 85.8 deaths per 100,000 standard population. CONCLUSION This study found that mortality increases as people age, and 85% of deaths were found to be of people older than 65 years. The mortality was two times higher among white and Hispanic males than females. Findings from this study are important in understanding the sociodemographic characteristics at the county level, which can inform diabetes mortality prevention efforts.
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Affiliation(s)
- Ali Mamoon Alfalki
- College of Health Professions, University of New England, Biddeford, ME 04005, USA
| | - Ziyad Tariq Muhseen
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, Nanjing University, Nanjing, Jiangsu 210093, China
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Rosinha P, Saraiva M, Ferreira L, Garrido S, Carvalho A, Freitas C, Amaral C, Costa L, Loureiro L, Carvalho R. A Retrospective Cohort Study on Diabetic Foot Disease: Ascertainment of Ulcer Locations by Age Group. Cureus 2022; 14:e28189. [PMID: 36158367 PMCID: PMC9491625 DOI: 10.7759/cureus.28189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/11/2022] Open
Abstract
Background and aims Diabetic foot ulcer location is a known independent predictor for cure with a better healing gradient proximal to distal. Although advanced age is one of the main factors associated with greater diabetic foot ulcer severity, there are no studies evaluating diabetic foot ulcer location specifically in the elderly population in an outpatient setting. This study evaluated diabetic foot ulcer location and age-group interactions in diabetic foot presentation. Methods A retrospective cohort study including adult patients with diabetic foot ulcers observed on their first visit to our center's Diabetic Foot Unit in 2018, divided into younger adults (YA) (18 to 64 years) and older adults (OA) (≥65 years). Results A total of 435 patients were included in the study with 159 (36.6%) in the YA, and 276 (63.4%) in the OA group. Neuro-ischemic diabetic foot ulcers were more frequent in the OA group (71.4% vs 43.4%, p<0.001). The number of patients with a history of diabetic foot ulcers was lower in the OA group (18.1% vs 25.2%, p=0.03). A smaller proportion of forefoot diabetic foot ulcers (74.9% vs 86.2%, p=0.007) and plantar location diabetic foot ulcers (9.4% vs 24.5%, p<0.001) occurred in the OA group. By univariate logistic regression analysis, we found two associations with older age: proximal (odds ratio (OR) 2.09 (1.23-3.53), p=0.006), and non-plantar (OR 3.13 (1.82-5.37), p<0.001) diabetic foot ulcer location. After adjusting for potential confounders in a multivariate analysis, older age lost the association to more proximal (OR 1.72 (0.94-3.15), p=0.081) and non-plantar (OR 1.78 (0.83-3.77), p=0.133) diabetic foot ulcer location. Conclusions There are essential age differences in diabetic foot ulcer presentation. The OA group more frequently presents neuro-ischemic diabetic foot ulcers with more proximal and non-plantar locations.
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Polikandrioti M. Quality of life in diabetic foot ulcer, grade 3: associated demographic factors. Folia Med (Plovdiv) 2022; 64:229-239. [DOI: 10.3897/folmed.64.e64876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction: Patients with diabetic foot ulcer grade 3 experience some limitations that adversely affect their quality of life (QoL).
Aim: The aim of the study was to explore demographic characteristics associated with the quality of life of diabetic foot ulcer patients, grade 3.
Materials and methods: The present study recruited 120 diabetic foot ulcer patients. Data collected by completion of SF-36 Health Survey (SF-36).
Results: Of the 120 participants, 65.8% were men and 73% were more than 60 years of age. Patients showed moderate to high levels of quality of life in social functionality, energy/fatigue, emotional well-being, and physical pain (medians: 50, 60, 72, and 67.5, respectively) and poor levels in physical functioning, role physical, and role emotional (medians: 22, 0 and 0, respectively). In addition, patients had moderate levels of quality of life in general health (median: 48.5). It was observed that physical functioning was significantly associated with place of residence (p=0.005). Moreover, physical role was significantly associated with age (p=0.020) and occupation (p=0.018), while emotional role was significantly associated with age (p=0.012), marital status (p=0.016), and occupation (p=0.012). Energy/fatigue was significantly associated with age (p=0.026), marital status (p=0.018), and occupation (p=0.009). Emotional well-being was significantly associated with gender (p=0.009), level of education (p=0.001), and occupation (p=0.007). Social functionality was significantly associated with marital status (p=0.001) while pain was significantly associated with education level (p=0.010). General health was significantly associated with marital status (p=0.037), and place of residence (p=0.024).
Conclusions: The findings of the present study may adequately inform stakeholders in the field of diabetic foot ulcer grade 3 when planning effective care.
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GAMAL WM, OMAR MA, RASHWAN AH, MOHAMED AF. Role of autologous platelet rich plasma in management of chronic wounds. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Altoijry A, AlGhofili H, Alanazi SN, AlHindawi DA, AlAkeel NS, Julaidan BS, AlHamzah M, Altuwaijri T. Diabetic foot and peripheral arterial disease. Single centre experience. Saudi Med J 2021; 42:49-55. [PMID: 33399171 PMCID: PMC7989311 DOI: 10.15537/smj.2021.1.25640] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/14/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To determine the prevalence of vasculopathic diabetic foot and the associated factors in a Saudi tertiary center. Methods: This retrospective chart review included adult patients (≥18 years) diagnosed with diabetic foot between May 2015 and July 2019 in King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia. Based on clinical presentation and laboratory results, the patients were categorized into 2 groups namely, "vascular induced diabetic foot group" and "non-vascular induced diabetic foot group". RESULTS A total of 404 diabetic patients were enrolled in the study. The mean age of the patients was 62.03±12.30 years; 61.9% were males. Most of the diabetic foot cases had a non-vascular etiology (n=327, 80.9%), while 77 cases (19.1%) were due to vasculopathy. Patient in the vascular group had a significantly higher incidence of coronary artery disease (32.5% versus 14.4%; p greater than 0.001), and a higher incidence of peripheral artery disease (PAD) in the unaffected limb (22.1% versus 2.1%; p less than 0.001). Conclusion: Most cases of diabetic foot were due to non-vascular causes. Old age, history of coronary artery disease, or PAD in the unaffected limb were factors that were significantly associated with diabetic foot due to arterial disease.
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Affiliation(s)
- Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Moitinho MS, Yamachi CY, González CVS, de Gouveia Santos VLC, Gamba MA. Determinantes sociales y demográficos relacionados con la cicatrización de heridas en un centro de asistencia y educación en enfermería. J Wound Care 2020; 29:44-53. [PMID: 33251959 DOI: 10.12968/jowc.2020.29.latam_sup_3.44] [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 Analyse the social and demographic variables that affect healing in patients with hard-to-heal wounds. METHOD This retrospective study looked at 349 patient records of people with hard-to-heal wounds at an educational and care centre in San Pablo, Brazil, between 1994 and 2015. Healing was measured using the Pressure Ulcer Scale for Healing (PUSH). RESULTS A total of 128 patient records were included. Most had identified themselves as white (62%), with an incomplete education (31%), household income under three minimum wages (86%), diabetes mellitus (61%), and systemic hypertension (58.4%). The PUSH scale varied between 4-7. The healing rate was 60%. Patients with white/yellow skin had 3.43 more chances to achieve healing (p<0,001). CONCLUSION The social determinants observed were similar to Brazil's major inequality indicators. Statistical significance for white/yellow skin colour related to wound healing was observed. Nursing consultations contributed in achieving wound healing.
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Affiliation(s)
| | - Cintia Yurie Yamachi
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, San Pablo, Brasil
| | - Carol V Serna González
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA), Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Vera L C de Gouveia Santos
- Programa de Posgrado en Enfermería en la Salud del Adulto (PROESA), Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil.,Departamento de Enfermería Médico-quirúrgica, Escola de Enfermagem, Universidade de São Paulo, San Pablo, Brasil
| | - Mônica Antar Gamba
- Departamento de Enfermería y salud colectiva, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, San Pablo, Brasil
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Hüsers J, Hafer G, Heggemann J, Wiemeyer S, John SM, Hübner U. Predicting the amputation risk for patients with diabetic foot ulceration - a Bayesian decision support tool. BMC Med Inform Decis Mak 2020; 20:200. [PMID: 32838777 PMCID: PMC7446175 DOI: 10.1186/s12911-020-01195-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023] Open
Abstract
Background Diabetes mellitus is a major global health issue with a growing prevalence. In this context, the number of diabetic complications is also on the rise, such as diabetic foot ulcers (DFU), which are closely linked to the risk of lower extremity amputation (LEA). Statistical prediction tools may support clinicians to initiate early tertiary LEA prevention for DFU patients. Thus, we designed Bayesian prediction models, as they produce transparent decision rules, quantify uncertainty intuitively and acknowledge prior available scientific knowledge. Method A logistic regression using observational collected according to the standardised PEDIS classification was utilised to compute the six-month amputation risk of DFU patients for two types of LEA: 1.) any-amputation and 2.) major-amputation. Being able to incorporate information which is available before the analysis, the Bayesian models were fitted following a twofold strategy. First, the designed prediction models waive the available information and, second, we incorporated the a priori available scientific knowledge into our models. Then, we evaluated each model with respect to the effect of the predictors and validity of the models. Next, we compared the performance of both models with respect to the incorporation of prior knowledge. Results This study included 237 patients. The mean age was 65.9 (SD 12.3), and 83.5% were male. Concerning the outcome, 31.6% underwent any- and 12.2% underwent a major-amputation procedure. The risk factors of perfusion, ulcer extent and depth revealed an impact on the outcomes, whereas the infection status and sensation did not. The major-amputation model using prior information outperformed the uninformed counterpart (AUC 0.765 vs AUC 0.790, Cohen’s d 2.21). In contrast, the models predicting any-amputation performed similarly (0.793 vs 0.790, Cohen’s d 0.22). Conclusions Both of the Bayesian amputation risk models showed acceptable prognostic values, and the major-amputation model benefitted from incorporating a priori information from a previous study. Thus, PEDIS serves as a valid foundation for a clinical decision support tool for the prediction of the amputation risk in DFU patients. Furthermore, we demonstrated the use of the available prior scientific information within a Bayesian framework to establish chains of knowledge.
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Affiliation(s)
- Jens Hüsers
- Health Informatics Research Group, Department of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück, Germany
| | - Guido Hafer
- Niels Stensen Kliniken, Christliches Klinikum, Melle, Germany
| | - Jan Heggemann
- Niels Stensen Kliniken, Christliches Klinikum, Melle, Germany
| | - Stefan Wiemeyer
- Niels Stensen Kliniken, Christliches Klinikum, Melle, Germany
| | - Swen Malte John
- Department Dermatology, Environmental Medicine, Health Theory, University of Osnabrück, Osnabruck, Germany
| | - Ursula Hübner
- Health Informatics Research Group, Department of Business Management and Social Sciences, University of Applied Sciences Osnabrück, Osnabrück, Germany.
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Pontes DÊG, Silva ITDACE, Fernandes JJ, Monteiro ADEFÁG, Gomes PHDAS, Ferreira MGM, Lima FGDE, Correia JDEO, Santos NJND, Cavalcante LP. Microbiologic characteristics and antibiotic resistance rates of diabetic foot infections. ACTA ACUST UNITED AC 2020; 47:e20202471. [PMID: 32667581 DOI: 10.1590/0100-6991e-20202471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/19/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. METHODS it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. RESULTS the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. CONCLUSIONS the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.
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Affiliation(s)
- DÊnisson Guedes Pontes
- Programa de Pós-Graduação (Mestrado Profissional) em Cirurgia, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | | | | | | | | | | | | | | | | | - Leonardo Pessoa Cavalcante
- Programa de Pós-Graduação (Mestrado Profissional) em Cirurgia, Universidade Federal do Amazonas, Manaus, AM, Brazil
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Fernandes FCGDM, Santos EGDO, Morais JFGD, Medeiros LMDF, Barbosa IR. O cuidado com os pés e a prevenção da úlcera em pacientes diabéticos no Brasil. ACTA ACUST UNITED AC 2020. [DOI: 10.1590/1414-462x202028020258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Resumo Introdução O Diabetes Mellitus configura-se como um problema de saúde pública em ascensão e, uma vez mal controlado, favorece o desenvolvimento de complicações altamente incapacitantes, como o pé diabético. Objetivo avaliar a prevalência e os fatores associados às ações de prevenção das úlceras dos pés em pacientes diabéticos no Brasil. Método Trata-se de um estudo transversal que utilizou dados da Pesquisa Nacional de Saúde 2013, relativos à proporção de indivíduos com diagnóstico de diabetes em relação às recomendações do cuidado e a prevalência de úlcera nos pés. A PNS sorteou um total de 81.187 domicílios, sendo selecionado um indivíduo por domicílio, sendo entrevistadas 60.202 pessoas. Resultados A realização do exame dos pés em portadores de diabetes por profissionais de saúde foi maior na Região Sudeste e a menor na Região Centro-Oeste. A não realização do exame foi mais prevalente no sexo feminino, em residente em área rural, de cor/raça parda, solteiro, sem instrução ou ensino fundamental incompleto. No Brasil, apenas 58,4% dos pacientes diabéticos que fizeram consulta regular receberam a orientação para examinar os pés; a ocorrência de ferida no pé foi significativamente maior para o sexo masculino; na raça-cor preta/parda; a presença de ferida no pé foi significativamente maior entre os pacientes diabéticos que faziam consulta regularmente. Conclusão Desse modo, no Brasil, a adesão dos profissionais na orientação para prevenção de úlceras diabéticas é considerada precária, com as menores prevalências de realização do cuidado nos grupos mais vulneráveis.
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Gontijo PVC, Pascoal LM, Santos LHD, Santos FAAS, Rolim ILTP, Santos Neto M, Brito PDS. Assessment of tissular integrity in patients with diabetic foot. Rev Bras Enferm 2020; 73:e20200032. [DOI: 10.1590/0034-7167-2020-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/24/2020] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: Evaluate the impairment of tissue integrity in patients with diabetic foot and verify its association with time of diagnosis of the disease. Methods: Cross-sectional study conducted with 134 patients in an outpatient clinic located in the Northeast region of Brazil. A semi-structured questionnaire was used for data collection, which was subjected to descriptive analysis and the Mann-Whitney U non-parametric test. Results: Indicators with the lowest average score were: skin temperature, sweating, skin lesions, right and left pedal pulses, right and left tibial pulses. Patients less than ten years old had worse scores on thickness, elasticity, right tibial pulse and tissue integrity. Those with a diagnosis time of more than ten years had a greater impairment of sensation and right pulse. Conclusion: All indicators showed some impairment of tissue integrity, and the time of diagnosis of the disease was associated with six of these.
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Wang X, Li J, Wang Z, Deng A. Wound exudate CXCL6: a potential biomarker for wound healing of diabetic foot ulcers. Biomark Med 2019; 13:167-174. [PMID: 30605352 DOI: 10.2217/bmm-2018-0339] [Citation(s) in RCA: 10] [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
AIM The aim of this study was to investigate the relationship between CXCL-6 levels in wound exudates and healing of diabetic foot ulcers (DFU). MATERIALS & METHODS One hundred patients with neuropathic DFU were recruited. Wound exudate CXCL-6 levels were measured by enzyme-linked immunosorbent assay. Patients were followed for 24 weeks and divided into rapidly healing and nonhealing groups. RESULTS Compared with the NH group, the mean CXCL-6 levels in the wound exudates of the rapidly healing group were significantly higher. After adjusting for traditional risk factors, wound exudate CXCL-6 levels were still significantly associated with wound healing. CONCLUSION CXCL6 is an independent predictor of wound healing in DFU patients and may be a potentially novel therapeutic target for the treatment of DFU.
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Affiliation(s)
- Xiufang Wang
- Department of Pain, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430021, PR China
| | - Juyi Li
- Department of Pharmacy, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430021, PR China
| | - Zhongjing Wang
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430021, PR China
| | - Aiping Deng
- Department of Pharmacy, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430021, PR China
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Stojanović M, Cvetanović G, Anđelković Apostolović M, Stojanović D, Rančić N. Impact of socio-demographic characteristics and long-term complications on quality of life in patients with diabetes mellitus. Cent Eur J Public Health 2018; 26:104-110. [PMID: 30102498 DOI: 10.21101/cejph.a5022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/14/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Diabetes mellitus (DM) has been one of the leading chronic diseases worldwide over past decades. The objective of the study was to identify predictors associated with health-related quality of life (HRQOL) in diabetic patients. METHODS A cross-sectional questionnaire-based study was conducted at the General Hospital of the city of Leskovac, between June and November 2015. The Short Form-36 (SF-36) questionnaire, EuroQol-5D (EQ-5D) and EuroQol-VAS (EQ-VAS) questionnaires were used. Univariate and multivariate linear regression analyses were performed. RESULTS The total number of patients was 285, 112 men (39.3%) and 173 women (60.7%), average age 63.92 ± 1.07 years. The results of multiple linear regression of socio-demographic characteristics in relation to dimensions of the quality of life measured by SF-36 and EQ-VAS showed that age, country (rural) life, low level of education, retirement, and poor economic status are predictors of lower quality of life. Our results showed that employment has a significant association with higher Physical Component Score (PCS), Mental Component Score (MCS) and EQ-VAS score, which can be explained with higher incomes, improved economic status and less possibility for the occurrence of depressive mood. Patients without formal education have lower QOL. Univariate multiple regression analysis of the presence of micro- and macrovascular complications of DM showed that angina pectoris, heart failure, diabetic retinopathy, and diabetic nephropathy are the most important factors affecting the quality of life in our population. After including the multivariate model, all tested complications remained statistically significant. CONCLUSION Our results showed that both socioeconomic and chronic complications are relevant factors of HRQOL in type 1 and 2 diabetes mellitus patients. Age, rural lifestyle, retirement, lower level of education and low socioeconomic status, as well as DM complications (angina pectoris, hearth failure, diabetes nephropathy, and diabetes retinopathy) were found to be independent risk factors for the component scores of SF-36 and EQ-VAS score. Taking into consideration the results obtained, health practitioners should be aware not only of the clinical parameters of patients with DM, but also of their educational level and working status.
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Affiliation(s)
- Miodrag Stojanović
- University of Niš, Faculty of Medicine Niš, Niš, Serbia.,Department of Biostatistics, Institute for Public Health, Niš, Serbia
| | | | - Marija Anđelković Apostolović
- University of Niš, Faculty of Medicine Niš, Niš, Serbia.,Department of Biostatistics, Institute for Public Health, Niš, Serbia
| | | | - Nataša Rančić
- University of Niš, Faculty of Medicine Niš, Niš, Serbia.,Centre for Control and Prevention of Diseases, Institute of Public Health, Niš, Serbia
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Bonafé FSS, de Campos LA, Marôco J, Campos JADB. Brief Pain Inventory: A proposal to extend its clinical application. Eur J Pain 2018; 23:565-576. [PMID: 30365196 DOI: 10.1002/ejp.1330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/22/2018] [Accepted: 10/20/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study presents an adaptation of the Brief Pain Inventory (BPI) extending its use in clinical/epidemiological contexts and the evaluation of the properties of BPI (short form) in a sample of Brazilian adults. METHODS Part of item 1 of this instrument was removed because it prevented the participation of individuals with usual pain. In addition to the reference period of original response "last 24 hr," a new period "last pain experience" was proposed. Individuals responded about the presence/lack and onset of pain. Individuals who reported pain in the last 24 hr before the interview answered the BPI considering both reference periods. Confirmatory factor analysis was performed to check the fit of five theoretical BPI models. RESULTS A total of 1,176 adults participated (79.0% women; 38.7 (SD = 10.8) years), 29.2% did not report pain in the last 24 hr, 33.6% reported pain <3 months and 37.2% pain ≥3 months. All theoretical BPI models presented adequate fit indices (GFI ≥ 0.9; RMSEA < 0.1; α ≥ 0.7) when both reference periods were used. In conclusion, the adaptations proposed can contribute to extend the use of BPI. CONCLUSIONS The reference period of responses and the theoretical model used must be chosen according to the needs of the researcher and/or physician. SIGNIFICANCE This study presents evidence related to the validity of applying the Brief Pain Inventory (BPI) in adults with and without pain considering the present pain or memory of pain, enabling the clinician to collect additional information that may be relevant to the clinical management of pain.
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Affiliation(s)
| | | | - João Marôco
- William James Center for Research (WJCR), University Institute of Psychological, Social, and Life Sciences (ISPA), Lisbon, Portugal
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Tanharo D, Ghods R, Pourrahimi M, Abdi M, Aghaei S, Vali N. Adherence to Treatment in Diabetic Patients and Its Affecting Factors. PAJOUHAN SCIENTIFIC JOURNAL 2018. [DOI: 10.21859/psj.17.1.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zeng X, Tang Y, Hu K, Jiao W, Ying L, Zhu L, Liu J, Xu J. Three-week topical treatment with placenta-derived mesenchymal stem cells hydrogel in a patient with diabetic foot ulcer: A case report. Medicine (Baltimore) 2017; 96:e9212. [PMID: 29390468 PMCID: PMC5758170 DOI: 10.1097/md.0000000000009212] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Diabetic foot ulcer (DFU) is a chronic complication of diabetes characterized by continuity, repeatability, and nonhealing. In recent years, mesenchymal stem cells hydrogel complex has been a new emerging technique in the treatment of DFU. The placenta-derived mesenchymal stem cells (PDMSCs) hydrogel is multipotent, and can secrete growth factors, cytokines, and immunomodulatory substances which could accelerate wound healing. PATIENT CONCERNS In this case report, we present a 57-year-old female with type 2 diabetes mellitus and a 20-day DFU.A wound bed located at the dorsalis pedis of the right foot, and conventional therapies had no effect on the foot. DIAGNOSES The patient was confirmed a diagnosis of type 2 DM with diabetic foot (Wagner classification III). INTERVENTIONS To assess the efficacy and safety of PDMSCs hydrogel in wound repair and to improve the rate of wound healing, we administered PDMSCs hydrogel (cell number: 1 × 10/cells/cm) topically into the wound with the patient's permission. OUTCOMES The patient's foot ulcer was almost healed, and foot function in walking was well preserved. No complications were observed. No recurrence occurred in the subsequent 6 months. LESSONS To the best of our knowledge, this is the first patient globally to receive PDMSCs hydrogel to treat DFU. The present case study suggests that PDMSCs hydrogel may provide a new approach to DFU treatment. Clinical Trial Registration-URL: http://www.chictr.org.cn/searchproj.aspx:chiCRT-ONC-16008732.
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Silva EFF, Ferreira CMM, Pinho LD. Risk factors and complications in type 2 diabetes outpatients. Rev Assoc Med Bras (1992) 2017; 63:621-627. [PMID: 28977088 DOI: 10.1590/1806-9282.63.07.621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 12/19/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Our study investigated type 2 diabetes mellitus (T2DM) outpatients attending a university hospital in Montes Claros, MG, to estimate the prevalence of risk factors and their association with diabetes complications. METHOD This was a quantitative, documental, retrospective and analytical study. Medical records of 95 outpatients with T2DM treated in this hospital from 2011 to 2015 were analyzed. Data were collected according to a structured questionnaire surveying sociodemographic, anthropometric and biochemical data and clinical and lifestyle aspects. Regression analysis was used to evaluate the association between risk factor variables and complications. RESULTS With a mean age of 54 years, the study population showed irregular blood glucose control, despite the use of hypoglycemic medication, and did not have a healthy lifestyle. The main complication reported was high blood pressure (HBP), occurring in 70.9% of patients. The prevalence of complications was positively associated with patients receiving insulin treatment (p=0.042) and multidisciplinary monitoring (p=0.050). CONCLUSION The associations identified reflect the condition of patients that were already treating diabetes and its complications, especially HBP. The characteristics of the study population indicate the need to improve clinical follow-up and increase motivation for healthy behaviors.
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Affiliation(s)
| | | | - Lucineia de Pinho
- PhD in Health Sciences, Unimontes and Funorte, Montes Claros, MG, Brazil
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23
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Pedras S, Carvalho R, Pereira MG. A predictive model of anxiety and depression symptoms after a lower limb amputation. Disabil Health J 2017; 11:79-85. [PMID: 28395911 DOI: 10.1016/j.dhjo.2017.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/15/2017] [Accepted: 03/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with Diabetic Foot Ulcer (DFU) show high levels of depression and anxiety symptoms. The loss of a limb is undoubtedly a devastating experience and several studies have shown that anxiety and depression symptoms are a common reaction after a lower limb amputation (LLA). However, no study has focused on the immediate emotional reactions to LLA as a personal factor based on the ICF Model. OBJECTIVE This study focused on the characterization of anxiety and depression levels, before and after surgery, differences in levels of depression and anxiety before and after surgery and the predictors of anxiety and depression one month after surgery, in a sample of patients with DFU. METHODS This was a longitudinal study with 179 patients with Diabetes Mellitus Type 2 and DFU indicated for amputation, screened for the presence of anxiety and depression symptoms during the hospitalization that preceded amputation and one month after surgery, during a follow-up consultation. RESULTS The results showed a significant effect of anxiety and depression symptoms at pre-surgery in the prediction of anxiety and depression symptoms one month after LLA. Patients showed higher levels of anxiety than depression symptoms at pre-surgery, although anxiety significantly decreased on month after surgery. Both anxiety and depression symptoms contributed to depression after LLA, although anxiety at pre-surgery was the only predictor of anxiety at post-surgery. CONCLUSIONS Tailored multidisciplinary interventions need to be developed providing support before and after an amputation surgery, in order to reduce anxiety and depression symptoms and promote psychological adjustment to limb loss.
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Affiliation(s)
- Susana Pedras
- School of Psychology, Applied Psychology Department, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
| | - Rui Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - M Graça Pereira
- School of Psychology, Applied Psychology Department, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
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Development of a Survey to Explore Factors Influencing the Adoption of Best Practices for Diabetic Foot Ulcer Offloading. J Wound Ostomy Continence Nurs 2017; 44:129-137. [DOI: 10.1097/won.0000000000000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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