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Abstract
BACKGROUND Sexual and gender minorities constitute a rapidly growing part of the older adult population in the United States and may face quality of life (QOL) challenges in older adulthood. Research on quality of life among lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults has increased dramatically since 2010. Common findings indicate that LGBTQ older adults face challenges related to personal experiences of discrimination, anticipated discrimination in health care settings, and lack of family support. Research designs were primarily nonprobability surveys, with a small number of qualitative designs and surveys using representative probability samples. AIM To identify and summarize research on QOL among LGBTQ older adults conducted in the United States between January 1, 2000 and December 31, 2020. METHOD Four scholarly databases were searched to identify studies addressing QOL in LGBTQ older adult populations. RESULTS The database search produced a total 568 unique results. Of these, 54 research articles were identified that met all inclusion criteria for the review. Appraisal of evidence was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. CONCLUSIONS Care for mental health of LGBTQ older adults should be sensitive to issues including lifetime history of discrimination, anxiety about anticipated discrimination from health care providers, and potential lack of family support. Focus can also be given to common areas of strength, including strengthening nonfamily social networks.
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Affiliation(s)
- Russell Preston
- Russell Preston, MS, RN, University of Rochester School of Nursing, Rochester, NY, USA
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Byrnes J, Ward L, Jensen S, Sagoo M, Charles D, Mann R, Nghiem S, Finch J, Gavaghan B, McBride LJ, Lazzarini PA. Health-related quality of life in people with different diabetes-related foot ulcer health states: A cross-sectional study of healed, non-infected, infected, hospitalised and amputated ulcer states. Diabetes Res Clin Pract 2024; 207:111061. [PMID: 38104903 DOI: 10.1016/j.diabres.2023.111061] [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: 07/18/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
AIMS Diabetes-related foot ulcers (DFU) are a leading cause of infection, hospitalisation and amputation. However, to our knowledge no studies have compared the health-related quality of life (HRQoL) of people with DFU that were infected, hospitalised or amputated. This study aimed to investigate and compare the HRQoL of different groups of people with healed, non-infected, infected, hospitalised, or amputated DFU. METHODS This was a multi-centre cross-sectional study measuring the HRQoL of patients, attending one of 18 Diabetic Foot Services across Queensland, Australia, with one of five DFU health states: healed, non-infected, infected, hospitalised, amputated. HRQoL was measured using the EQ-5D-5L to estimate age-sex adjusted utility values. RESULTS Of 376 included patients (mean age 63 (12) years, 75% male), age-sex adjusted HRQoL utility estimates (95% CIs) were: healed DFU 0.57 (0.51-0.64), non-infected DFU 0.55 (0.49-0.62), infected DFU 0.45 (0.36-0.55), hospitalised DFU 0.53 (0.42-0.64), and amputated DFU 0.55 (0.46-0.63). CONCLUSION People in any DFU health state have considerably reduced HRQoL, with greatest reductions in those with infected DFU. These findings provide valuable HRQoL estimates and comparisons for several different important DFU health states, adding to our understanding of the impact of DFU on HRQoL and facilitating future economic evaluations.
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Affiliation(s)
- Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia.
| | - Lauren Ward
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Sarah Jensen
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Manjeet Sagoo
- Diabetes Resource Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Danielle Charles
- Cairns Diabetes Centre, Cairns and Hinterland Hospital and Health Service, and Metro North Hospital and Health Service, Queensland, Australia
| | - Rebecca Mann
- Chronic Disease Brisbane South, Community and Oral Health, Inala Community Health Centre, Metro South Health, Queensland, Australia
| | - Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Jennifer Finch
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Belinda Gavaghan
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Liza-Jane McBride
- Office of the Chief Allied Health Officer, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Peter A Lazzarini
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Mairghani M, Sorensen J, Elmusharaf K, Patton D, Moore Z. The health-related quality of life in patients with diabetic foot ulcers in the Kingdom of Bahrain. J Tissue Viability 2023; 32:465-471. [PMID: 37385873 DOI: 10.1016/j.jtv.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023]
Abstract
AIMS The aims of this study were to assess the health-related quality of life (HRQoL) of adult Bahraini patients with diabetic foot ulcers (DFU) and to explore factors associated with poor HRQoL. METHODS Cross-sectional HRQoL data were obtained from a sample of patients in active treatment for DFU at a large public hospital in Bahrain. Patient-reported HRQOL was measured using the following instruments: DFS-SF, CWIS and EQ-5D. RESULTS The patient sample included 94 patients, with a mean age of 61.8 (SD: 9.9) years, 54 (57.5%) were males, and 68 (72.3%) were native Bahrainis. Poorer HRQoL was found among patients who were unemployed, divorced/widowed, and those with a shorter duration of formal education. Additionally, patients with severe DFUs, persisting ulcers, and a longer duration of diabetes reported statistically significantly poorer HRQoL. CONCLUSIONS Findings from this study demonstrate a low level of HRQoL among Bahraini patients with DFUs. A longer duration of diabetes, in addition to ulcer severity and status statistically significantly influence HRQoL.
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Affiliation(s)
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Khalifa Elmusharaf
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Declan Patton
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Zena Moore
- Royal College of Surgeons in Ireland, Dublin, Ireland.
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Roehrs H, Stocco JG, Pott F, Blanc G, Meier MJ, Dias FA. Dressings and topical agents containing hyaluronic acid for chronic wound healing. Cochrane Database Syst Rev 2023; 7:CD012215. [PMID: 37497805 PMCID: PMC10373121 DOI: 10.1002/14651858.cd012215.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Hyaluronic acid is synthesised in plasma membranes and can be found in extracellular tissues. It has been suggested that the application of hyaluronic acid to chronic wounds may promote healing, and the mechanism may be due to its ability to maintain a moist wound environment which helps cell migration in the wound bed. OBJECTIVES To evaluate the effects of hyaluronic acid (and its derivatives) on the healing of chronic wounds. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was February 2022. SELECTION CRITERIA We included randomised controlled trials that compared the effects of hyaluronic acid (as a dressing or topical agent) with other dressings on the healing of pressure, venous, arterial, or mixed-aetiology ulcers and foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 12 trials (13 articles) in a qualitative synthesis, and were able to combine data from four trials in a quantitative analysis. Overall, the included trials involved 1108 participants (mean age 69.60 years) presenting 178 pressure ulcers, 54 diabetic foot ulcers, and 896 leg ulcers. Sex was reported for 1022 participants (57.24% female). Pressure ulcers It is uncertain whether there is a difference in complete healing (risk ratio (RR) 1.17, 95% confidence interval (CI) 0.58 to 2.35); change in ulcer size (mean difference (MD) 25.60, 95% CI 6.18 to 45.02); or adverse events (none reported) between platelet-rich growth factor (PRGF) + hyaluronic acid and PRGF because the certainty of evidence is very low (1 trial, 65 participants). It is also uncertain whether there is a difference in complete healing between lysine hyaluronate and sodium hyaluronate because the certainty of evidence is very low (RR 2.50, 95% CI 0.71 to 8.83; 1 trial, 14 ulcers from 10 participants). Foot ulcers in people with diabetes It is uncertain whether there is a difference in time to complete healing between hyaluronic acid and lyophilised collagen because the certainty of evidence is very low (MD 16.60, 95% CI 7.95 to 25.25; 1 study, 20 participants). It is uncertain whether there is a difference in complete ulcer healing (RR 2.20, 95% CI 0.97 to 4.97; 1 study, 34 participants) or change in ulcer size (MD -0.80, 95% CI -3.58 to 1.98; 1 study, 25 participants) between hyaluronic acid and conventional dressings because the certainty of evidence is very low. Leg ulcers We are uncertain whether there is a difference in complete wound healing (RR 0.98, 95% CI 0.26 to 3.76), percentage of adverse events (RR 0.79, 95% CI 0.22 to 2.80), pain (MD 2.10, 95% CI -5.81 to 10.01), or change in ulcer size (RR 2.11, 95% CI 0.92 to 4.82) between hyaluronic acid + hydrocolloid and hydrocolloid because the certainty of evidence is very low (1 study, 125 participants). It is uncertain whether there is a difference in change in ulcer size between hyaluronic acid and hydrocolloid because the certainty of evidence is very low (RR 1.02, 95% CI 0.84 to 1.25; 1 study, 143 participants). We are uncertain whether there is a difference in complete wound healing between hyaluronic acid and paraffin gauze because the certainty of evidence is very low (RR 2.00, 95% CI 0.21 to 19.23; 1 study, 24 ulcers from 17 participants). When compared with neutral vehicle, hyaluronic acid probably improves complete ulcer healing (RR 2.11, 95% CI 1.46 to 3.07; 4 studies, 526 participants; moderate-certainty evidence); may slightly increase the reduction in pain from baseline (MD -8.55, 95% CI -14.77 to -2.34; 3 studies, 337 participants); and may slightly increase change in ulcer size, measured as mean reduction from baseline to 45 days (MD 30.44%, 95% CI 15.57 to 45.31; 2 studies, 190 participants). It is uncertain if hyaluronic acid alters incidence of infection when compared with neutral vehicle (RR 0.89, 95% CI 0.53 to 1.49; 3 studies, 425 participants). We are uncertain whether there is a difference in change in ulcer size (cm2) between hyaluronic acid and dextranomer because the certainty of evidence is very low (MD 5.80, 95% CI -10.0 to 21.60; 1 study, 50 participants). We downgraded the certainty of evidence due to risk of bias or imprecision, or both, for all of the above comparisons. No trial reported health-related quality of life or wound recurrence. Measurement of change in ulcer size was not homogeneous among studies, and missing data precluded further analysis for some comparisons. AUTHORS' CONCLUSIONS There is currently insufficient evidence to determine the effectiveness of hyaluronic acid dressings in the healing of pressure ulcers or foot ulcers in people with diabetes. We found evidence that hyaluronic acid probably improves complete ulcer healing and may slightly decrease pain and increase change in ulcer size when compared with neutral vehicle. Future research into the effects of hyaluronic acid in the healing of chronic wounds should consider higher sample size and blinding to minimise bias and improve the quality of evidence.
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Affiliation(s)
- Hellen Roehrs
- Department of Nursing, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Janislei Gd Stocco
- Hospital Infection Control & Prevention, Clinical Hospital of Federal University of Paraná, Curitiba, Brazil
| | - Franciele Pott
- Department of Primary Care and Emergency, Hospital Polícia Militar do Paraná, São José dos Pinhais, Brazil
| | - Gisely Blanc
- Department of Primary Care and Emergency, Prefeitura de São José dos Pinhais, Curitiba, Brazil
| | - Marineli J Meier
- Department of Nursing and Postgraduate Nursing Program, Federal University of Paraná, Curitiba, Brazil
| | - Fernando Al Dias
- Department of Physiology, Federal University of Paraná, Curitiba, Brazil
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Sherrill CH, Lee S. Prevalence, characteristics, and health-related quality of life of continuous glucose monitoring use according to the Behavioral Risk Factor Surveillance System 2014-2020. J Manag Care Spec Pharm 2023; 29:541-549. [PMID: 37121248 PMCID: PMC10387903 DOI: 10.18553/jmcp.2023.29.5.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND: Continuous glucose monitoring (CGM) can improve behavioral and clinical outcomes. The use of CGM in real-world practice appears to be increasing. However, actual prevalence and characteristics of using CGM in real-world practice are unknown. OBJECTIVE: To investigate the prevalence of CGM use by American adults with diabetes mellitus and differences in demographics and health-related quality of life (HRQOL) between users of CGM and self-monitoring of blood glucose (SMBG). METHODS: This serial cross-sectional study using 2014-2020 Behavioral Risk Factor Surveillance System data included nonpregnant adults with self-reported diabetes using CGM or 4-15 times daily SMBG. Outcomes were prevalence of CGM use, demographics, and the 4-item Centers for Disease Control and Prevention HRQOL (CDC HRQOL-4). Unadjusted analysis was performed using univariable regression, and adjusted analysis was performed using nearest neighbor matching to compare CDC HRQOL-4 between SMBG and CGM groups in SAS Studio version 5.2. RESULTS: Among 12,053 included respondents, 231 (1.9%) reported using CGM, and prevalence increased from 0.4% in 2014 to 4.1% in 2020. Compared with SMBG users, CGM users were more likely to be younger (50.3 years vs 56.1 years; P < 0.001), employed (59.6% vs 30.6%; P = 0.001), earn at least $75,000/year (48.5% vs 22.0%, P < 0.001), have insurance coverage (99.7% vs 95.4%; P = 0.005), and report fewer comorbidities (history of myocardial infarction, stroke, arthritis, depressive disorder, and kidney disease; all P < 0.05). After nearest neighbor matching, diabetes management-related characteristics were shown to have statistically significant differences between CGM and SMBG users including: age at diabetes diagnosis (30.6 vs 35.6 years; P = 0.005), not seeing a doctor because of cost concern (2.6% vs 7.8%; P = 0.011), checking hemoglobin A1c biannually (91.3% vs 86.6%; P = 0.047), performing daily foot self-examination (58.9% vs 69.6%; P = 0.028), receiving foot examination by a health care professional annually (87.9% vs 93.5%; P = 0.048), and receiving a shingles vaccine in the past (16.5% vs 10.1%; P = 0.024). CDC HRQOL-4 were shown to be similar between the 2 groups across the 4 domains (general health, physical, mental, and combined physical and mental health). CONCLUSIONS: An increased trend in CGM use was observed from 2014 to 2020. Economic factors were associated with CGM use over SMBG, and CGM use did not show a difference in HRQOL measured across the 4 domains.
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Affiliation(s)
- Christina H Sherrill
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, NC
| | - Sun Lee
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, NC
- Analysis Group, Boston, MA
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Haryanto H, Makmuriana L, Hartono H, Dwi Arini D, Ariyanti S, Sari Y, Ronas MR, Junaidi J, Ervita L. Quality of life in patients with recurrent diabetic foot ulcers. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2023. [DOI: 10.15452/cejnm.2022.13.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
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Pasangha E, George B, Bhuvana KB, Padmini D. Predictors of Pharmacotherapy and Quality of Life Among Patients With Diabetic Foot Syndrome: A Cross-Sectional Study from a Tertiary Care Hospital in India. J Pharmacol Pharmacother 2022. [DOI: 10.1177/0976500x221080291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To assess the patterns and predictors of pharmacotherapy and QOL in DFS patients in an Indian tertiary care hospital. Methods: A cross-sectional study was conducted among inpatients with DFS. Data on sociodemographic and clinical factors, pharmacotherapy, clinical outcomes, and QOL were analyzed using the chi-squared test, independent sample t-test, and binary logistic regression. Results: We screened 3284 inpatients and included consecutive 87 (2.7%) DFS patients. The mean age was 56.08 ± 11.05 years, with a male preponderance (75.8%). Mean HbA1c was 9.9 ± 2.483. About 75% of patients received insulin, and polypharmacy was noticed in 82.7%. About 67.8% of DFS patients had other vascular complications of diabetes, with diabetic retinopathy being the most common in 89%. Amputations were noticed in 32.1% of patients. Overall, poor QOL was seen in 79.3% of patients. The mean scores for different domains were as follows: physical, 41.51 ± 14.15; psychological, 42.90 ± 11.16; social relationships, 43.06 ± 19.36; and environment, 47.17 ± 13. The presence of complications from diabetes was a significant predictor of the utilization of antihypertensives (OR: 2.92, CI [1.09, 7.79], P = 0.03) and poor QOL (OR: 4.54, CI [0.965, 21.41], P = 0.05). Conclusion: DFS patients in this study were found to be younger with poor glycemic control and other vascular complications of diabetes. The presence of other complications of diabetes in DFS patients was found to be a predictor of pharmacotherapy and poor QOL.
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Affiliation(s)
- E. Pasangha
- St. John’s Medical College, Sarjapur Road, Bangalore, Karnataka, India
| | - B. George
- Department of Endocrinology, St. Johns Medical College, Sarjapur Road, Bangalore, Karnataka, India
| | - K. B. Bhuvana
- Department of Pharmacology, St. Johns Medical College, Sarjapur Road, Bangalore, Karnataka, India
| | - D. Padmini
- Department of Pharmacology, St. Johns Medical College, Sarjapur Road, Bangalore, Karnataka, India
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Lee DM, Grose E, Cross K. Internet-Based Patient Education Materials Regarding Diabetic Foot Ulcers: Readability and Quality Assessment. JMIR Diabetes 2022; 7:e27221. [PMID: 35014960 PMCID: PMC8790680 DOI: 10.2196/27221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/11/2021] [Accepted: 10/16/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND While diabetic foot ulcers (DFU) are a common complication of diabetes, little is known about the content and readability of online patient education materials (PEM) for DFU. The recommended reading grade level for these materials is grades 6-8. OBJECTIVE The aim of this paper was to evaluate the quality and readability of online PEM on DFU. METHODS A Google search was performed using 4 different search terms related to DFU. Two readability formulas were used to assess the readability of the included PEM. These included the Flesch-Kincaid grade level and the Flesch-Reading ease score. The DISCERN tool was used to determine quality and reliability. RESULTS A total of 41 online PEM were included. The average Flesch-Reading ease score for all PEM was 63.43 (SD 14.21), indicating a standard difficulty level of reading. The average reading grade level was 7.85 (SD 2.38), which is higher than the recommended reading level for PEM. The mean DISCERN score was 45.66 (SD 3.34), and 27% (11/41) of the articles had DISCERN scores of less than 39, corresponding to poor or very poor quality. CONCLUSIONS The majority of online PEM on DFU are written above the recommended reading levels and have significant deficiencies in quality and reliability. Clinicians and patients should be aware of the shortcomings of these resources and consider the impact they may have on patients' self-management.
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Affiliation(s)
- David Michael Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elysia Grose
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Karen Cross
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Plastic Surgery, St. Michael's Hospital, Toronto, ON, Canada
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Clinical assessment of endovenous thermal ablation combined with concomitant phlebectomy for the treatment of lower limb varicose veins with or without poor glycemic control. Surgery 2021; 171:1427-1433. [PMID: 34823897 DOI: 10.1016/j.surg.2021.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed to investigate the clinical results of endovenous thermal ablation combined with stab phlebectomy for unilateral varicose veins based on diabetic management. METHODS The study reviewed 501 patients who underwent endovenous thermal ablation combined with stab phlebectomy for unilateral varicose veins, including 337 nondiabetics (control group) and 164 diabetics. Diabetics with hemoglobin A1c ≥7% were classified as the poor glycemic control group, and hemoglobin A1c <7% as the good glycemic control group. Surgical outcomes were assessed by Venous Clinical Severity Score. The Chronic Venous disease quality of life Questionnaire was used to assess the quality of life. RESULTS Lower limb varicose veins can be treated successfully with endovenous thermal ablation combined with stab phlebectomy in patients with or without poor glycemic control, accompanied by a significant improvement in health status. For patients with initial varicose veins (preoperative Venous Clinical Severity Score <10), the results revealed satisfactory improvements in Venous Clinical Severity Score and quality of life among the control, poor glycemic control, and good glycemic control groups. Patients with advanced varicose veins (preoperative Venous Clinical Severity Score ≥10) also showed an obvious amelioration concerning venous symptoms and quality of life. However, the extent of improvement varied among the 3 groups. Patients subjected to advanced varicose veins with the condition of poor glycemic control exhibited a less desirable improvement in postoperative health conditions compared with the control and good glycemic control groups, especially in edema relief and ulcer healing. CONCLUSION Endovenous thermal ablation combined with stab phlebectomy is safe and effective in the treatment of varicose veins with or without poor glycemic control. Clinical attempts at hemoglobin A1c management may contribute to improved clinical outcomes in patients with advanced varicose veins.
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Pan CW, Liu RJ, Yang XJ, Ma QH, Xu Y, Luo N, Wang P. Could the EQ-5D-3L predict all-cause mortality in older Chinese? Evidence from a 5-year longitudinal study in eastern China. Qual Life Res 2021; 30:2887-2894. [PMID: 34028640 DOI: 10.1007/s11136-021-02883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the ability of the 3-level EQ-5D (i.e., EQ-5D-3L) in predicting all-cause mortality in older Chinese adults. METHODS The data were from a 5-year longitudinal study, Weitang Geriatric Diseases Study, including 4579 community-dwelling older people in eastern China, with the mean age of 72.5 years at baseline and female being 52.0%. Three multivariable logistic regression models were adopted to assess the associations of the baseline EQ-5D data [i.e., the EQ-5D problems, EQ-5D-3L index score, and EQ-5D visual analog scale (VAS) score] with the 5-year all-cause mortality, adjusting for socio-demographic characteristics, and subsequently, health conditions and lifestyle habits. RESULTS A total of 183 participants died over the 5-year study period. A larger proportion of the dead reported problems in physical dimensions (i.e., including three dimensions: mobility, self-care, and usual activities, p < 0.05 for all). The mean EQ-5D index score (0.928) and EQ-VAS score (79.7) of the living were higher than those of the dead (0.915 and 73.2, p < 0.05 for both). In multivariable logistic analyses, the EQ-5D health problems in the physical-related dimensions [odds ratio (OR) 2.16, p < 0.05] and the EQ-VAS score (OR: 0.97, p < 0.001) were associated with the 5-year all-cause mortality when adjusting for socio-demographic characteristics, health conditions, and lifestyle habits. CONCLUSIONS It appears that the EQ-5D-3L could predict mortality in general older Chinese, which could be used to detect high-risk older individuals in China.
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Affiliation(s)
- Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Rui-Jie Liu
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China
| | - Xue-Jiao Yang
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Qing-Hua Ma
- The 3rd People's Hospital of Xiangcheng District, Suzhou, China
| | - Yong Xu
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pei Wang
- School of Public Health, Fudan University, 130 Dong An Road, Shanghai, 200032, China. .,Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China.
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Struggling for normality: experiences of patients with diabetic lower extremity amputations and post-amputation wounds in primary care. Prim Health Care Res Dev 2020; 21:e63. [PMID: 33323161 PMCID: PMC7801928 DOI: 10.1017/s146342362000064x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: To explore the experiences of patients living with diabetic lower extremity amputation (DLEA) and its post-amputation wound in primary care. Background: DLEA, including both minor and major amputation, is a life-altering condition that brings numerous challenges to an individual’s life. Post-amputation physical wound healing is complicated and challenging because of wound dehiscence and prolonged healing times. Understanding patients’ experiences after DLEA with a post-amputation wound will enable healthcare professionals to develop interventions to assist patients in physical healing and psychosocial recovery. Methods: This study employs a qualitative design using interpretative phenomenological analysis (IPA). A purposive maximum variation sample of nine patients who had had lower extremity amputations and post-amputation wound attributed to diabetes in the previous 12 months was recruited from a primary care setting in Singapore. Semi-structured audio recorded one-to-one interviews with a duration of 45–60 min each were conducted between September 2018 and January 2019. The interviews were transcribed verbatim and analysed using IPA. Findings: The essential meaning of the phenomenon ‘the lived experiences for patients with DLEA and post-amputated wound’ can be interpreted as ‘struggling for “normality”’ which encompasses four domains of sense making: physical loss disrupted normality, emotional impact aggravated the disrupted normality, social challenges further provoked the disrupted normality, and attempt to regain normality. The study highlights the complex physical and psychosocial transition facing patients after DLEA before post-amputation wound closure. In primary care, an amputation, whether minor or major, is a life-altering experience that requires physical healing, emotional recovery, and social adaptation to regain normality. Patients living with DLEA and a post-amputation wound may benefit from an interdisciplinary team care model to assist them with physical and psychosocial adjustment and resume normality.
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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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13
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Azharuddin M, Kapur P, Adil M, Ghosh P, Sharma M. Health-related quality of life and sleep quality among North Indian type 2 diabetes mellitus patients: evidence from a cross-sectional study. Sleep Med 2020; 73:93-100. [PMID: 32799030 DOI: 10.1016/j.sleep.2020.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/12/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study is to measure the relationship between sleep quality and health-related quality of life (HRQOL), in Indian population with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional study, included a total of 300 patients with T2DM. All participants were responding to the Pittsburgh Sleep Quality Index (PSQI) and European Quality of Life-5 Dimensions Questionnaire (EQ-5D). A PSQI global score ≥5 was defined as poor sleep quality. EQ-5D visual analogue scale (VAS), determining the overall health status. Logistic regression analysis was used to examine the association between PSQI and EQ-5D. All the study data were analysed using the SPSS software version 20.0. Values of p < 0.05 were considered statistically significant. RESULTS The mean age of included participants were 55.29. Majority of the participants (55.3%) were identified as "poor sleepers" and female (31.3%) contributing higher proportion. Poor sleepers had significantly lower the HRQoL (p < 0.001). After adjustment, poor sleep quality was significantly associated with a lower HRQoL; EQ-5D index (OR = 1.080, 95%, CI: 1.015-1.148, p < 0.05), and EQ-5D VAS (OR = 1.092, 95%, CI: 1.021-1.176, p < 0.01). Overall, the EQ-5D index and EQ-5D VAS were found to be an independent predictors of sleep quality. CONCLUSIONS Poor sleep quality is prevalent in Indian T2DM population, and it imparts negative impact on several dimensions of EQ-5D that characterising the daily activities performance. Therefore, further real-world studies are needed to determine the causal relationship between T2DM patients and measure of objective sleep and their impact on health.
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Affiliation(s)
- Md Azharuddin
- Department of Pharmaceutical Medicine, Division of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Prem Kapur
- Department of Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, 110062, India.
| | - Mohammad Adil
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Pinaki Ghosh
- Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth, Pune, 411038, India
| | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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14
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Westby M, Norman G, Vedhara K, Game F, Cullum N. Psychosocial and behavioural prognostic factors for diabetic foot ulcer development and healing: a systematic review. Diabet Med 2020; 37:1244-1255. [PMID: 32315474 DOI: 10.1111/dme.14310] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 12/31/2022]
Abstract
AIM To investigate whether ulceration, amputation and healing of foot ulcers in people living with diabetes are associated with psychosocial and behavioural factors. METHODS We searched MEDLINE, Embase, PsychINFO, CINAHL and The Cochrane Library to March 2019 for longitudinal studies with multivariable analyses investigating independent associations. Two reviewers extracted data and assessed risk of bias. RESULTS We identified 15 eligible studies involving over 12 000 participants. Clinical and methodological heterogeneity precluded meta-analysis, so we summarize narratively. Risk of bias was moderate or high. For ulceration, we found significantly different results for people with and without an ulcer history. For those with no ulcer history, moderate quality evidence suggests depression increases ulcer risk [three studies; e.g. hazard ratio (HR) 1.68 (1.20, 2.35) per Hospital Anxiety and Depression Scale (HADS) standard unit]. Better foot self-care behaviour reduces ulcer risk [HR 0.61 (0.40, 0.93) per Summary of Diabetes Self-Care Activities scale standard unit; one study]. For people with diabetes and previous ulcers, low- or very low-quality evidence suggests little discernible association between ulcer recurrence and depression [e.g. HR 0.88 (0.61, 1.27) per HADS standard unit], foot self-care, footwear adherence or exercise. Low-quality evidence suggests incomplete clinic attendance is strongly associated with amputation [odds ratio (OR) 3.84 (1.54, 9.52); one study]. Evidence for the effects of other psychosocial or behavioural factors on ulcer healing and amputation is very low quality and inconclusive. CONCLUSIONS Psychosocial and behavioural factors may influence the development of first ulcers. More high quality research is needed on ulcer recurrence and healing. (Open Science Framework Registration: https://osf.io/ej689).
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Affiliation(s)
- M Westby
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation , Manchester, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - G Norman
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation , Manchester, UK
| | - K Vedhara
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - F Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - N Cullum
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation , Manchester, UK
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15
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McCarthy M, Yates T, Webb D, Game F, Gray L, Davies MJ. Health impacts of seated arm ergometry training in patients with a diabetic foot ulcer: protocol for a randomised controlled trial. BMJ Open 2020; 10:e039062. [PMID: 32565482 PMCID: PMC7311002 DOI: 10.1136/bmjopen-2020-039062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Once diagnosed with a diabetic foot ulcer (DFU), patients are advised to offload, keeping pressure off the foot in order to facilitate ulcer healing. An increase in offloading is often accompanied by reductions in physical activity which can worsen the overall health of patients.While unable to perform traditional forms of upright activity, one mode of exercise that would allow patients to be physically active while adhering to offloading instruction is seated arm ergometry. The merits of tailored aerobic exercise in DFU remain unexplored. METHODS AND ANALYSIS This is a prospective open-label randomised controlled trial. Participants will be randomised to one of two groups, an exercise intervention group or control. The intervention group are required to undertake arm ergometry training at a moderate intensity (65%-75% HRpeak), three times per week for 12 weeks as individually prescribed by an exercise physiologist, while the control group will continue to receive standard care alone. Assessment of outcome measures will occur at baseline and after the intervention period, these will include: a seated VO2 peak test, a blood sample, a short physical performance battery, a dual-energy X-ray absorptiometry scan and completing a range of health-based questionnaires. The above will be used to determine: cardiorespiratory fitness, metabolic health, physical function, body composition and quality of life, respectively. Ulcer area will also be measured as an approximate marker of ulcer healing. ETHICS AND DISSEMINATION This trial has been approved by 'Yorkshire & The Humber-Leeds West Research Ethics Committee' (19/YH/0269). Trial results will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER ISRCTN16000053. Registered in accordance with WHO Trial Registration Data Set (version 1.3.1).
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Affiliation(s)
- Matthew McCarthy
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - David Webb
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Frances Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Laura Gray
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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16
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A Longitudinal Study on the Association Between Diabetic Foot Disease and Health-Related Quality of Life in Adults With Type 2 Diabetes. Can J Diabetes 2020; 44:280-286.e1. [DOI: 10.1016/j.jcjd.2019.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/25/2019] [Accepted: 08/19/2019] [Indexed: 01/13/2023]
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17
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Sen P, Demirdal T. Evaluation of mortality risk factors in diabetic foot infections. Int Wound J 2020; 17:880-889. [PMID: 32196927 DOI: 10.1111/iwj.13343] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
Identifying risk factors for mortality is crucial in the management of diabetic foot syndrome. We aimed to evaluate risk factors for mortality in patients with diabetic foot infection (DFI). A retrospective chart review was conducted on 401 patients from 2010 through 2019. Our primary endpoint was in-hospital mortality. Patients were divided into two groups according to the outcome (survival or death). Clinical data were compared between the two groups statistically. A total of 401 patients were enrolled in the study, 280 (69.8%) of them were male and the mean age was 59.6 ± 11.1 years. The mean follow-up period was 23.7 ± 22.9 months. In-hospital mortality rate was 3%. Univariate analysis indicated that ischaemic wound (P = .023), hindfoot infection (P = .038), whole foot infection (P = .010), peripheral arterial disease (P = .024), high leucocyte levels (>12 040 K/μL) (P = .001), high thrombocyte levels (>378 000 K/μL) (P < 0.001), high C-reactive protein levels (>8.81 mg/dL) (P = .022), and polymicrobial growth in deep tissue culture (P = .041) were significant parameters in predicting mortality. In multivariate analysis, peripheral arterial disease (odds ratio [OR]: 13.430, 95% confidence interval [Cl]: 1.129-59.692; P = .040), high thrombocyte levels (OR: 1.000, 95% Cl: 1.000-1.000; P = .022), and polymicrobial growth in deep tissue culture (OR: 7.790, 95% Cl: 1.592-38.118; P = .011) were independent risk factors for mortality. In conclusion, peripheral arterial disease, high thrombocyte levels, and polymicrobial growth in deep tissue culture were independent risk factors for mortality in DFI.
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Affiliation(s)
- Pinar Sen
- Department of Infectious Diseases and Clinical Microbiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Tuna Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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18
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Sayyed Kassem L, Aron DC. The assessment and management of quality of life of older adults with diabetes mellitus. Expert Rev Endocrinol Metab 2020; 15:71-81. [PMID: 32176560 DOI: 10.1080/17446651.2020.1737520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished.Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed.Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient's capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.
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Affiliation(s)
- Laure Sayyed Kassem
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Aron
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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19
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Linertová R, Del Pino-Sedeño T, Pérez LG, Aragón-Sánchez J, Andia-Ortiz I, Trujillo-Martín M, Iruzubieta-Barragan FJ, Serrano-Aguilar P. Cost-effectiveness of Platelet-Rich Plasma for Diabetic Foot Ulcer in Spain. INT J LOW EXTR WOUND 2020; 20:119-127. [PMID: 32037919 DOI: 10.1177/1534734620903239] [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
This study evaluated the cost-effectiveness of platelet-rich plasma (PRP) added to usual care versus usual care alone in elderly patients with chronic diabetic foot ulcer (DFU) from the Spanish health care system perpective. A 6-state Markov model with 3-month cycles was used to estimate costs and outcomes of wound healing and risk of recurrences, infections, and amputations over 5 years. Three treatment strategies were compared: (a) usual care plus PRP obtained with a commercial kit, (b) usual care plus PRP obtained manually, and (c) usual care. Data on effectiveness were taken from a recent meta-analysis. Outcomes and costs were discounted at 3% and resources were valued in 2018 euro. Compared with usual care, the PRP treatment with the manual method was more effective and less costly (dominant option), whereas the PRP treatment with the commercial kit was more effective but also more costly, with the incremental ratio being above the cost-effectiveness threshold (€57 916 per quality-adjusted life year). These results are sensitive to the price of PRP kits (a 20% discount would make the PRP treatment a cost-effective option) and effectiveness data, due to the heterogeneity of primary studies. In conclusion, PRP treatment for DFUs could be considered a cost-effective or even cost-saving alternative in Spain, depending on the method of obtaining the PRP. Despite the dominance of the manual method, its general use is limited to hospitals and specialized centers, whereas PRP kits could be used in primary care settings, but their prices should be negotiated by health authorities.
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Affiliation(s)
- Renata Linertová
- Canary Islands Foundation of Health Research (FIISC), Santa Cruz de Tenerife, Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Barcelona, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Tasmania Del Pino-Sedeño
- Canary Islands Foundation of Health Research (FIISC), Santa Cruz de Tenerife, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain
| | - Lidia-García Pérez
- Canary Islands Foundation of Health Research (FIISC), Santa Cruz de Tenerife, Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Barcelona, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain
| | | | | | - Mar Trujillo-Martín
- Canary Islands Foundation of Health Research (FIISC), Santa Cruz de Tenerife, Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Barcelona, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain
| | | | - Pedro Serrano-Aguilar
- Health Services and Chronic Diseases Research Network (REDISSEC), Barcelona, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain.,Canary Islands Health Service (SESCS), Santa Cruz de Tenerife, Spain
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20
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Guo Z, Li X, Wang T, Liu J, Chen B, Fan L. Effectiveness of iliac vein stenting combined with high ligation/endovenous laser treatment of the great saphenous veins in patients with Clinical, Etiology, Anatomy, Pathophysiology class 4 to 6 chronic venous disease. J Vasc Surg Venous Lymphat Disord 2020; 8:74-83. [DOI: 10.1016/j.jvsv.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022]
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21
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Pedras S, Vilhena E, Carvalho R, Pereira MG. Quality of Life Following a Lower Limb Amputation in Diabetic Patients: A Longitudinal and Multicenter Study. Psychiatry 2020; 83:47-57. [PMID: 31652411 DOI: 10.1080/00332747.2019.1672438] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Lower limb amputation (LLA) leads to several emotional and physical sequelaes that have a negative impact on individuals` life. The objectives of this study were: 1) to analyze the relationship between emotional reactions (anxiety, depression and traumatic stress symptoms) and functionality level, before and after a LLA due to diabetic foot ulcer, and mental/physical quality of life; and 2) to analyze the mediator role of social support between emotional reactions and mental/physical quality of life. Method: A multicenter, longitudinal study with four time assessments: before the surgery, one month, six months, and ten months after surgery, including 206 individuals hospitalized with diabetic foot ulcer indicated for a LLA. The instruments used were the following: Revised Impact of Event Scale; Barthel Index; Hospital Anxiety and Depression Scale and SF-36. Results: Anxiety symptoms before surgery and depression symptoms one month after surgery contribute to Mental Component Score (MCS) ten months after surgery. The level of functionality before and one month after surgery, traumatic stress symptoms one month after surgery as well as satisfaction with social support six months after surgery contribute to the Physical Component Score (PCS), ten months after surgery. Social support was a mediator between traumatic stress symptoms one month after surgery and PCS ten months after surgery. Conclusion: Identifying risk variables and the extent to which and when they affect mental/physical quality of life, will help to develop appropriate psychological interventions to promote quality of life in this population.
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22
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Rezaie W, Lusendi F, Doggen K, Matricali G, Nobels F. Health-related quality of life in patients with diabetic foot ulceration: study protocol for adaptation and validation of patient-reported outcome measurements (PROMs) in Dutch-speaking patients. BMJ Open 2019; 9:e034491. [PMID: 31874898 PMCID: PMC7008415 DOI: 10.1136/bmjopen-2019-034491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Diabetic foot ulceration (DFU) is a common late-stage complication of diabetes with a large impact on health status and quality of life. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients' views on their well-being. The DFU Scale Short Form (DFS-SF) is a validated disease-specific PROM for measuring health-related quality of life among DFU patients. The Lower Extremity Functional Scale (LEFS) is another PROM that can be used to measure physical functioning in patients with lower extremity disorders. The LEFS is not yet validated for DFU. Both instruments are not validated in the Dutch language. The purpose of this study is to culturally adapt and validate the DFS-SF and LEFS questionnaires for Belgian Dutch-speaking patients with DFU. METHODS AND ANALYSIS This study will be conducted as a monocentre observational cohort study in DFU patients presenting at a hospital-based multidisciplinary diabetic foot clinic. Data will be collected from the medical electronic files and from DFS-SF, LEFS and five-level EuroQol five-dimension questionnaires that will be presented to the patients at defined time points. Reproducibility, internal consistency, floor and ceiling effects, construct validity and responsiveness will be assessed for the DFS-SF and LEFS. ETHICS AND DISSEMINATION The study protocol has been approved by the Medical Ethics Committee of Onze-Lieve-Vrouw Hospital (Aalst, Belgium). The results of the study will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Wahid Rezaie
- Orthopaedics & Trauma, Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Flora Lusendi
- Health Services Research Unit, Belgian Scientific Institute of Public Health, Brussel, Belgium
| | - Kris Doggen
- Health Services Research Unit, Belgian Scientific Institute of Public Health, Brussel, Belgium
| | - Giovanni Matricali
- Multidisciplinary Diabetic Foot Clinic, KU Leuven Hospital, Leuven, Belgium
| | - Frank Nobels
- Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
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23
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Khunkaew S, Fernandez R, Sim J. Demographic and clinical predictors of health-related quality of life among people with type 2 diabetes mellitus living in northern Thailand: A cross-sectional study. Health Qual Life Outcomes 2019; 17:177. [PMID: 31796044 PMCID: PMC6889205 DOI: 10.1186/s12955-019-1246-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/15/2019] [Indexed: 11/14/2022] Open
Abstract
Background Type 2 Diabetes Mellitus (T2DM) is a chronic disease which is growing global health problems. However, research on such prediction of health-related quality of life (HRQOL) in Thailand is limited, in particular on the demographic and clinical characteristic in each HRQOL domains. Therefore, the aim of the present study was to determine the demographic and clinical predictors of health-related quality of life among people with type 2 diabetes mellitus (T2DM) in Northern Thailand. Methods A cross-sectional study of people with T2DM at a large teaching hospital in Northern Thailand was conducted. The HRQOL was evaluated using the Thai version of Diabetes-39. Descriptive analysis was used to summarize the demographic and HRQOL scores. Multiple regression analysis was used to determine the predictors of overall HRQOL and the predictors of each D-39 dimension. Results A total of 502 people with T2DM were recruited. Forty-one were identified as having diabetic foot ulcers. The mean score for perception of overall HRQOL was 61.18 (SD 18.74). Scores in the D-39 questionnaire showed a poor HRQOL among people with T2DM. The predictors of demographic and clinical characteristics of people with T2DM were calculated for overall HRQOL and all six domains. Conclusion These results demonstrate that people with T2DM have a poor HRQOL. The presence of diabetic foot ulcers and smoking status were identified as significant predictors of low HRQOL in the domains relating to diabetes control, social burden and energy and mobility presence of obesity, receiving insulin injection or a combination of insulin and oral medication were predictors of poor HRQOL in the domain of other health problems and diabetes complications. These findings allow for a nursing care plan for diabetes management to achieve optimal glycaemic control and improve their HRQOL.
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Affiliation(s)
- Saneh Khunkaew
- Boromarajonani of Nursing College Uttaradit, Praboromarajchanok Institute, 38/40 Jasadabordit Rd, Muang Uttaradit, 50300, Thailand.
| | - Ritin Fernandez
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
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24
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Gylfadottir SS, Weeracharoenkul D, Andersen ST, Niruthisard S, Suwanwalaikorn S, Jensen TS. Painful and non-painful diabetic polyneuropathy: Clinical characteristics and diagnostic issues. J Diabetes Investig 2019; 10:1148-1157. [PMID: 31222961 PMCID: PMC6717899 DOI: 10.1111/jdi.13105] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022] Open
Abstract
Diabetic neuropathy (DN) is a common complication of diabetes and can be either painful or non-painful. It is challenging to diagnose this complication, as no biomarker or clear consensus on the clinical definition of either painful or non-painful DN exists. Hence, a hierarchical classification has been developed categorizing the probability of the diagnosis into: possible, probable or definite, based on the clinical presentation of symptoms and signs. Pain is a warning signal of tissue damage, and non-painful DN therefore represents a clinical and diagnostic challenge because it often goes unnoticed until irreversible nerve damage has occurred. Simple clinical tests seem to be the best for evaluation of DN in the general care for diabetes. Screening programs at regular intervals might be the most optimal strategy for early detection and interventions to possibly prevent further neuronal damage and to lower the economic burden of this complication.
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Affiliation(s)
| | - Danita Weeracharoenkul
- Pain Management Research UnitDepartment of AnesthesiologyFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand
| | - Signe Toft Andersen
- Danish Pain Research CenterAarhus UniversityAarhusDenmark
- Department of Public HealthAarhus UniversityAarhusDenmark
| | - Supranee Niruthisard
- Pain Management Research UnitDepartment of AnesthesiologyFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand
| | - Sompongse Suwanwalaikorn
- Department of MedicineFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand
| | - Troels Staehelin Jensen
- Danish Pain Research CenterAarhus UniversityAarhusDenmark
- Department of NeurologyAarhus University HospitalAarhusDenmark
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Amadou C, Carlier A, Amouyal C, Bourron O, Aubert C, Couture T, Fourniols E, Ha Van G, Rouanet S, Hartemann A. Five-year mortality in patients with diabetic foot ulcer during 2009-2010 was lower than expected. DIABETES & METABOLISM 2019; 46:230-235. [PMID: 31400509 DOI: 10.1016/j.diabet.2019.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 11/24/2022]
Abstract
AIM Mortality rates are decreasing in patients with diabetes. However, as this observation also concerns patients with diabetic foot ulcer (DFU), additional data are needed. For this reason, our study evaluated the 5-year mortality rate in patients with DFU during 2009-2010 and identified risk factors associated with mortality. METHODS Consecutive patients who attended a clinic for new DFU during 2009-2010 were followed until healing and at 1 year. Data on mortality were collected at year 5. Multivariate Cox proportional-hazards model was used to identify mortality risk factors. RESULTS A total of 347 patients were included: mean age was 65±12 years, diabetes duration was 16 [10; 27] years; 13% were on dialysis; and 7% had an organ transplant. At 5 years, 49 patients (14%) were considered lost to follow-up. Total mortality rate at 5 years was 35%, and 16% in patients with neuropathy. On multivariate analyses, mortality was positively associated with: age [hazard ratio (HR): 1.05 (1.03-1.07), P<0.0001]; duration of diabetes [HR: 1.02 (1.001-1.03], P=0.03]; PEDIS perfusion grade 2 vs. 1 [HR: 2.35 (1.28-4.29), P=0.006)]; PEDIS perfusion grade 3 vs. 1 [HR: 3.14 (1.58-6.24), P=0.001); and ulcer duration at year 1 [HR 2.09 (1.35-3.22), P=0.0009]. CONCLUSION Mortality rates were not as high as expected despite the large number of comorbidities, suggesting that progress has been made in the health management of these patients. In particular, patients with neuropathic foot ulcer had a survival rate of 84% at 5 years.
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Affiliation(s)
- C Amadou
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Carlier
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - C Amouyal
- Inserm, Sorbonne-Université, Research Unit on Cardiovascular, Metabolic and Nutrition Diseases (UMRS-1166), Institute of Cardiometabolism and Nutrition, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - O Bourron
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - C Aubert
- Department of Internal Medicine, Fribourg Hospital, Fribourg, Switzerland
| | - T Couture
- Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Fourniols
- Department of Orthopedic Surgery, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Ha Van
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Rouanet
- StatEthic SASU, 73, rue Paul-Vaillant-Couturier, 92300 Levallois-Perret, France
| | - A Hartemann
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France.
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Lee YN. Translation and validation of the Korean version of the Diabetic Foot Ulcer Scale-Short Form. Int Wound J 2019; 16 Suppl 1:3-12. [PMID: 30793855 DOI: 10.1111/iwj.13025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to translate the Diabetic Foot Ulcer Scale-Short Form (DFS-SF) into Korean and evaluate its psychometric performance in patients with diabetic foot ulcers (DFUs). The DFS-SF was translated into Korean using translation guidelines from the World Health Organization. The Korean version of DFS-SF (DFS-SF-K) went through the full linguistic validation process and was evaluated in 320 Korean patients with DFU. For this study, Cronbach's alpha was used to evaluate the reliability of the DFS-SF-K. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and known-group validity were conducted to examine construct validity. Correlation of the DFS-SF-K with SF-36 was used to test concurrent validity of the DFS-SF-K. Cronbach's alpha was >0.70 for all scales. Factor loadings of the 29 items on the six subscales ranged from 0.82 to 0.95. The six-subscale model was validated by CFA (x2 /df = 4.55, P < 0.001, RMR = 0.06, GFI = 0.73, NFI = 0.90, TLI = 0.91, CFI = 0.92, RMSEA = 0.10). Spearman's correlations and known-groups comparisons supported construct validity. The newly translated DFS-SF-K may be used to assess the impact of QoL with DFUs in Korean patients.
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Affiliation(s)
- Ye-Na Lee
- Department of Nursing, College of Nursing, Korea University, Seoul, Republic of Korea
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Khunkaew S, Fernandez R, Sim J. Health-Related Quality of Life and Self-Care Management Among People With Diabetic Foot Ulcers in Northern Thailand. SAGE Open Nurs 2019; 5:2377960819825751. [PMID: 33415216 PMCID: PMC7774360 DOI: 10.1177/2377960819825751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/13/2018] [Accepted: 12/28/2018] [Indexed: 11/17/2022] Open
Abstract
Diabetic foot ulcers (DFUs) are a common complication of diabetes that impacts on the health-related quality of life (HRQOL). Foot care is an important factor in the self-care management of patients with DFUs. The objective of this study was to investigate the HRQOL and foot care management of people with DFUs. A cross-sectional study involving 41 people with DFUs was conducted at a large tertiary hospital in Northern Thailand. The Diabetic Foot Ulcer Scale-Short Form and the VA-Diabetes Foot Care Survey were used to assess the HRQOL and foot care management among people with DFUs. The majority of the participants were female (n = 24, 58.5%), and the mean age was 62.13 years. The scores for HRQOL in the six domains were as follows: leisure (66.95 ± 28.03), physical health (68.93 ± 28.51), dependence or daily life (80.08 ± 25.23), negative emotions (71.23 ± 29.48), worried about ulcers (62.20 ± 31.97), and bothered by ulcer care (69.36 ± 25.20). High scores indicate a high (good) HRQOL. Less than a third of the participants reported that they had received education about foot care management. Almost all participants reported that they washed their feet daily; however, a large proportion did not test the water temperature or use lubricants on their feet. Most of the participants did not have a mirror for checking under their feet (48.8%), and there was a lack of knowledge about how to use a mirror for foot inspections (51.2%). This study provides guidance for clinicians on the content and delivery of diabetes education programs for people with diabetes (and DFUs) in Northern Thailand. The findings provide guidance on existing knowledge and the need for programs to address barriers to foot self-care management both in terms of skills and attitudes.
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Affiliation(s)
- Saneh Khunkaew
- School of Nursing, University of Wollongong,
New South Wales, Australia
| | - Ritin Fernandez
- School of Nursing, University of Wollongong,
New South Wales, Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong,
New South Wales, Australia
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28
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Khunkaew S, Fernandez R, Sim J. Health-related quality of life among adults living with diabetic foot ulcers: a meta-analysis. Qual Life Res 2018; 28:1413-1427. [PMID: 30565072 DOI: 10.1007/s11136-018-2082-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To undertake a systematic review of the literature to investigate the HRQOL among adults living with DFUs. METHODS A systematic search of the medical and nursing/health content databases including MEDLINE, CINAHL, and PsycINFO was conducted up to November 2018. The methodological quality of each study was assessed independently by all authors using the Joanna Briggs Institute checklist. Data analysis was conducted using the Comprehensive Meta-analysis software. All analyses were performed using random-effects models and heterogeneity was quantified. RESULTS A total of 12 studies were included in the review. Overall, the HRQOL of participants in the studies was poor on four of eight subscales in the SF-36: physical functioning (mean = 42.75, SE 1.5); role physical (mean = 20.61, SE 3.4); general health (mean = 39.52, SE 1.7); and vitality (mean = 45.73, SE 2.8). In addition, presence of pain, high levels of C-reactive protein (> 10 mg/L), ulcer size > 5 cm2, Ankle Brachial Index < 0.9, high glycosylated haemoglobin and body mass index > 25 kg/m2 were associated with poorer HRQOL in people with DFUs. CONCLUSIONS This review has provided evidence indicating that people with DFUs have a significantly lower HRQOL. Evidence-based interventions to improve the HRQOL in this group of people is needed.
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Affiliation(s)
- Saneh Khunkaew
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Building 41, Wollongong, NSW, 2522, Australia.
| | - Ritin Fernandez
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Building 41, Wollongong, NSW, 2522, Australia
- Centre for Research in Nursing and Health, St George Hospital, Research and Education Building, Level 1, Kogarah, NSW, 2217, Australia
| | - Jenny Sim
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Building 41, Wollongong, NSW, 2522, Australia
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29
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Tzeravini E, Tentolouris A, Tentolouris N, Jude EB. Advancements in improving health-related quality of life in patients living with diabetic foot ulcers. Expert Rev Endocrinol Metab 2018; 13:307-316. [PMID: 30381974 DOI: 10.1080/17446651.2018.1541403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Diabetic foot ulcer (DFU) constitutes a burden to patients with diabetes deteriorating their quality of life. Health related quality of life (HRQoL) can now be quantified with the use of specific tools; some of them provide a holistic approach to patients' well-being, while others are disease specific or even region specific. Many of these tools are applicable to patients with DFU. This review will present current data about the impact different interventions in the management of DFU on quality of life related parameters. AREAS COVERED We performed a search of literature using keywords 'diabetes mellitus', 'diabetic foot ulcer', 'diabetic foot', 'health related quality of life', 'quality of life' and 'SF-36' to identify studies that contained data about the relationship between different interventions and quality of life of patients with diabetic foot ulcers. EXPERT COMMENTARY Available data are not sufficient to conclude on the impact of interventions aimed to heal DFU on HRQoL. There is need for more, better designed studies and meta-analysis to estimate the effect of treatments on HRQoL in patients with DFUs. The development of new, diabetic foot specific tools will help to improve our knowledge in this field.
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Affiliation(s)
- Evangelia Tzeravini
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Anastasios Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Nikolaos Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Edward B Jude
- b Department of Medicine, Diabetes Centre , Tameside Hospital NHS Foundation Trust , Ashton-under-Lyne , UK
- c Department of Medicine , Manchester University , Manchester , UK
- d Manchester Metropolitan University , Manchester , UK
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30
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Izadi M, Bozorgi M, Hosseine MS, Khalili N, Jonaidi-Jafari N. Health-related quality of life in patients with chronic wounds before and after treatment with medical ozone. Medicine (Baltimore) 2018; 97:e12505. [PMID: 30508881 PMCID: PMC6283103 DOI: 10.1097/md.0000000000012505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Ozone therapy has been used to treat numerous diseases. Indications of its therapeutic application are increasing, and evidence for its usefulness is growing. Evidence of its antibacterial and proliferative activity suggests its efficacy in treating chronic wounds. The current study evaluated the effect of ozone therapy on the health-related quality of life of patients with chronic wounds.In the present cross-sectional study, the health-related quality of life was evaluated in 86 patients with chronic wounds undergoing ozone therapy. To measure quality of life, 2 previously established questionnaires were used, the Cardiff wound impact questionnaire and the SF-36 questionnaire. Questionnaires were completed through interviews with the patients.A total of 86 patients with chronic wounds undergoing ozone therapy participated in this study. The mean age of participants was 58.91 years; 69.8% of them were male, 91.9% had diabetes mellitus, and 50% were receiving insulin therapy. Patients were under local (26.7%), systemic (9.3%), and local plus systemic (64%) protocols of ozone therapy. Mean overall quality of life reported by the patients was 6.2, and mean overall quality of life satisfaction was 6.02 (measured by the Cardiff Wound Impact Questionnaire). Mean physical quality of life measured by the SF-36 questionnaire was 39.12, and mean mental quality of life was 44.37 (measured by the same questionnaire). Among the included variables, the number of ozone therapy sessions was the strongest predictor of quality of life in both questionnaires and remained significant after different levels of adjustment.In addition to the significant improvement observed in the healing of chronic wounds, medical O3 therapy has also shown to effect a significant improvement in the health-related quality of life of patients and could be a valuable therapeutic option in chronic wound cases.
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Affiliation(s)
- Morteza Izadi
- Ozonecrc, Baqiyatallah University of Medical Sciences
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran
| | - Majedeh Bozorgi
- Faculty of Economics and Administrative Sciences, University of Mazandaran, Babolsar, Iran
| | | | - Nahid Khalili
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran
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Anderson SG, Shoo H, Saluja S, Anderson CD, Khan A, Livingston M, Jude EB, Lunt M, Dunn G, Heald AH. Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort. Diabetologia 2018; 61:959-967. [PMID: 29264632 PMCID: PMC6448990 DOI: 10.1007/s00125-017-4522-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/25/2017] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine whether social deprivation in the presence of diabetes is an independent predictor of developing a foot ulcer and separately of mortality. METHODS This was a primary-care-based retrospective analysis of 13,955 adults with type 1 (n = 1370) or type 2 (n = 12,585) diabetes after a median follow-up of 10.5 years. Demographic characteristics, indices of social deprivation and clinical variables were assessed at baseline. The primary outcomes were new foot ulceration (in those without a previous history of foot ulcers) and all-cause mortality. Cox proportional hazard models were used to describe the associations among foot ulceration, social deprivation and mortality. RESULTS The mean age of the population was 69.4 (range: 16-89) years. The incidence of foot ulceration was greater in individuals with type 2 (8.6%) compared with type 1 diabetes (4.8%). Occurrence was similar by sex, but increased with age and deprivation index. Individuals in the highest quintile of deprivation were 77% more likely to develop a foot ulcer compared with those in the lowest quintile (OR 1.77 [95% CI 1.45, 2.14], p < 0.0001). Overall, 2946 (21.1%) deaths were recorded. Compared with individuals without a foot ulcer, the development of a foot ulcer was associated with a higher age- and sex-adjusted mortality rate (25.9% vs 14.0%), and a 72% (HR 1.72 [95% CI 1.56, 1.90], p < 0.001) increased risk of mortality in those with type 2 diabetes. Risk of death increased by 14% per quintile of deprivation in a univariable analysis (HR 1.14 [95% CI 1.10, 1.17]). In multivariable Cox regression analyses, there was a 48% increased risk of mortality in individuals with a foot ulcer (HR 1.48 [95% CI 1.33, 1.66]) independent of the Townsend index score (HR 1.13 [95% CI 1.10, 1.17], per quintile), baseline age, sex, diabetes type, smoking status, hypertension, statin use, β-blocker use, metformin use, HbA1c levels and insulin use. CONCLUSIONS/INTERPRETATION This study confirms the high mortality rate in individuals with diabetes-related foot ulcers. In addition, socioeconomic disadvantage was found to be an independent effect modifier, contributing to an increased burden of mortality in people with diabetes who develop foot ulceration. In light of this, and as diabetes service configurations are orientated for the next 5-10 years, modelling of foot ulceration risk needs to take socioeconomic disadvantage into account.
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Affiliation(s)
- Simon G Anderson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | - Haika Shoo
- Diabetes and Endocrine Department, East Cheshire NHS Trust, Macclesfield, UK
| | - Sushant Saluja
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | | | - Adnan Khan
- Department of Endocrinology and Diabetes, Leighton Hospital, Crewe, UK
| | - Mark Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
| | - Edward B Jude
- Department of Diabetes and Endocrinology, Tameside Hospital NHS Foundation Trust, Ashton-under-Lyme, UK
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - George Dunn
- Department of Podiatry, East Cheshire NHS Trust, Macclesfield, UK
| | - Adrian H Heald
- Salford Royal NHS Foundation Trust, Diabetes and Endocrinology, Stott Lane, Salford, UK.
- School of Medical Sciences, Faculty of Biology, Medicine, and Health, and Manchester Academic Health Science Centre (MAHSC), The University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK.
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Bani-issa W, Al-Shujairi AM, Patrick L. Association between quality of sleep and health-related quality of life in persons with diabetes mellitus type 2. J Clin Nurs 2018; 27:1653-1661. [DOI: 10.1111/jocn.14221] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Wegdan Bani-issa
- Department of Nursing; College of Health Sciences; University of Sharjah; Sharjah United Arab Emirates
| | - Arwa M Al-Shujairi
- Research Institute of Medical and Health Sciences; University of Sharjah; Sharjah United Arab Emirates
| | - Linda Patrick
- Faculty of Nursing; University of Windsor; Windsor ON USA
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Wukich DK, Raspovic KM. Assessing Health-Related Quality of Life in Patients With Diabetic Foot Disease: Why Is It Important and How Can We Improve? The 2017 Roger E. Pecoraro Award Lecture. Diabetes Care 2018; 41:391-397. [PMID: 29463665 DOI: 10.2337/dci17-0029] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patient-reported outcomes (PROs) have become an important subject in the area of diabetes-related foot complications. Self-reported health-related quality of life (HRQOL) surveys can provide a generic measure of overall health (global) and can be disease specific (i.e., diabetes) or even region specific (i.e., lower-extremity function). Analysis of PRO measures utilizing validated instruments allows health care providers to determine whether medical and surgical treatments are providing patients with the highest level of outcome possible and are actually improving HRQOL. The 36-item Short Form (SF-36), EuroQol five-dimension questionnaire (EQ-5D-5L), and Foot and Ankle Ability Measure (FAAM) are examples of commonly used HRQOL surveys. Low HRQOL has been associated with higher rates of hospital admission and mortality in patients with diabetes. Previous studies have demonstrated that patients with diabetes-related foot disease have low self-reported physical quality of life but do not typically report low mental quality of life. The impact of mental quality of life may be underestimated in these patients using the SF-36. In this article, we will discuss several widely used outcome instruments used to measure patient HRQOL and the impact of diabetic foot disease on HRQOL. As health care providers, we must continue to adjust and modify our treatments to achieve the best patient outcomes and associated high quality of life. Assessing PROs will become increasingly important as health care systems transition from a volume-based reimbursement model to a value-based model.
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Affiliation(s)
- Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Boodoo C, Perry JA, Hunter PJ, Duta DI, Newhook SCP, Leung G, Cross K. Views of Patients on Using mHealth to Monitor and Prevent Diabetic Foot Ulcers: Qualitative Study. JMIR Diabetes 2017; 2:e22. [PMID: 30291089 PMCID: PMC6238864 DOI: 10.2196/diabetes.8505] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 01/15/2023] Open
Abstract
Background People with diabetes are at risk for diabetic foot ulcers (DFUs), which can lead to limb loss and a significant decrease in quality of life. Evidence suggests that mHealth can be an effective tool in diabetes self-management. mHealth presents an opportunity for the prevention and monitoring of DFUs. However, there is a paucity of research that explores its effectiveness in the DFU patient population, as well as the views and attitudes of these patients toward technology and mHealth. Objective This study aimed to explore the views, attitudes, and experiences of a diabetic patient population with or at risk of DFUs regarding technology, mHealth, and the diabetic foot. Methods We used a qualitative research approach using in-depth interviews with 8 patients with DFUs. Questions were structured around experience with technology, current health practices related to diabetic foot care, and thoughts on using an mHealth device that prevents and monitors DFUs. We transcribed and thematically analyzed all interviews. Results All patients had positive responses for an mHealth intervention aimed at preventing and monitoring DFUs. We found 4 themes in the data: diversity in use of technology, feet-checking habits, 2-way communication with health care professionals (HCPs), and functionality. There were varying levels of familiarity with and dependence on technology within this patient population. These relationships correlated with distinct generations found in North America, including baby boomers and Generation X. Furthermore, we found that most patients performed daily feet checks to monitor any changes in health. However, some did not perform feet checks prior to the development of a DFU. Patients expressed interest in 2-way communication with HCPs that would allow for easier appointment scheduling, sharing of medical data, decreased number of visits, and use of alerts for when medical attention is required. Patients also identified conditions of functionality for the mHealth intervention. These included consideration of debilitating complications because of diabetes, such as retinopathy and decreased mobility; ease of use of the intervention; and implementation of virtual communities to support continued use of the intervention. Conclusions Our patient population expressed an interest in mHealth for preventing and monitoring DFUs, although some participants were not frequent users of technology. mHealth continues to show potential in improving patient outcomes, and this study provides a foundation for designing interventions specific to a DFU population. Further research is needed to confirm these findings.
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Affiliation(s)
- Chris Boodoo
- Department of Medical Imaging, St Michael's Hospital, Toronto, ON, Canada
| | - Julie Ann Perry
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Paul John Hunter
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Dragos Ioan Duta
- Department of Medical Imaging, St Michael's Hospital, Toronto, ON, Canada
| | | | - General Leung
- Department of Medical Imaging, St Michael's Hospital, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Institute of Biomedical Engineering Science & Technology, Ryerson University, Toronto, ON, Canada
| | - Karen Cross
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Institute of Biomedical Engineering Science & Technology, Ryerson University, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
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35
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Siersma V, Thorsen H, Holstein PE, Kars M, Apelqvist J, Jude EB, Piaggesi A, Bakker K, Edmonds M, Jirkovská A, Mauricio D, Reike H, Spraul M, Uccioli L, Urbancic V, van Acker K, van Baal J, Schaper NC. Diabetic complications do not hamper improvement of health-related quality of life over the course of treatment of diabetic foot ulcers - the Eurodiale study. J Diabetes Complications 2017; 31:1145-1151. [PMID: 28457703 DOI: 10.1016/j.jdiacomp.2017.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
AIMS Diabetic complications, and in particular diabetic foot ulcers (DFUs), are associated with low health-related quality of life (HRQoL). We evaluated whether the presence of diabetic complications also influenced the improvement of HRQoL during DFU treatment. METHODS 1088 patients presenting for DFU treatment at the centers participating in the Eurodiale study were followed prospectively up to one year. HRQoL was measured both at presentation and after healing or at end of follow up, using EQ-5D: a standardized instrument consisting of five domains and a summary index. The influence of diabetic comorbidity on the course of HRQoL was evaluated for each of the EQ-5D outcomes in multi-level linear regression analyses, adjusting for baseline characteristics. RESULTS HRQoL improved in all EQ-5D outcomes over the course of treatment for those DFUs that healed. The few significant differences in the development of HRQoL between patients with and without comorbidity showed a more beneficial development for patients with comorbidity in DFUs that did not heal or healed slowly. CONCLUSIONS Comorbidity does not hamper improvement of HRQoL in DFU treatment. On the contrary, HRQoL improved sometimes more in patients with certain comorbidity with hard-to-heal ulcers.
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Affiliation(s)
- Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Hanne Thorsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Per E Holstein
- Department of Dermatology and Venereology and Copenhagen Wound Healing Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Marleen Kars
- Division of Endocrinology, Department of Internal Medicine and Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan Apelqvist
- Department of Endocrinology, University of Malmö, Malmö, Sweden
| | - Edward B Jude
- Diabetes Centre, Tameside General Hospital, Ashton-under-Lyne, UK
| | - Alberto Piaggesi
- Sezione Dipartimentale Piede Diabetico, Dipartimento di Area Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Karel Bakker
- IDF Consultative Section and International Working Group on the Diabetic Foot, Heemstede, The Netherlands
| | | | - Alexandra Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Didac Mauricio
- Department of Endocrinology & Nutrition, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Luigi Uccioli
- Policlinico Tor Vergata, Department of Internal Medicine, Rome, Italy
| | - Vilma Urbancic
- Department of Endocrinology, University Medical Centre, Ljubljana, Slovenia
| | - Kristien van Acker
- H Familie Ziekenhuis & Centre de Santé des Fagnes, Department of Endocrinology, Rumst & Chimay, Belgium
| | - Jeff van Baal
- Department of Surgery, Twenteborg Ziekenhuis, Almelo, The Netherlands
| | - Nicolaas C Schaper
- Division of Endocrinology, Department of Internal Medicine and Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
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Kapp S, Santamaria N. The financial and quality-of-life cost to patients living with a chronic wound in the community. Int Wound J 2017. [PMID: 28635188 DOI: 10.1111/iwj.12767] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Chronic wounds are associated with financial and personal costs. The system level expense associated with chronic wounds has been established, however, the out-of-pocket cost incurred by individuals who self-fund has not been the focus of extensive investigation. Recently, there has been renewed interest in evaluating quality of life, in line with the shift to patient enablement and self-care in chronic disease management. The objectives of this research were to describe the out-of-pocket wound treatment costs and the quality of life of people who have chronic wounds. A questionnaire incorporating the Cardiff Wound Impact Schedule and purpose-designed instruments was completed by a non-probability, convenience sample of 113 people in Australia and Wales. Data was analysed using descriptive statistics. The sample was on average 63·6 years of age and had wounds that were on an average 109 weeks duration. Participants had spent on average AU$2475 on wound dressing products since the wound started, and AU$121·82 in the most recent 28 days which represented 10% of their disposable income. Health-related quality of life was sub-optimal, 6/10 (ave) according to the Cardiff Wound Impact Schedule. Younger participants reported significantly poorer quality of life on all CWIS sub-scales when compared to older participants. This study found that chronic wounds present a significant financial cost to individuals who must self-fund their wound dressings and other wound treatment related expenses. Participants who had access to wound product subsidisation also experienced personal financial costs. People who have chronic wounds experience sub-optimal quality of life therefore this condition is also costly to the individual's well-being. The quality of life of younger people has not received adequate attention and requires further consideration given the many years that younger people may have to live with this debilitating and often recurrent condition. Continued action is required to reduce the financial and personal costs experienced by people who have chronic wounds. It is imperative that healthcare funding is directed to people who have chronic wounds, in particular to alleviate the out-of-pocket costs experienced by self-funders. Continued attention to the quality of life of people who have chronic wounds is required to minimise the negative effects of this condition and enhance well-being.
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Affiliation(s)
- Suzanne Kapp
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Nick Santamaria
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Raspovic KM, Ahn J, La Fontaine J, Lavery LA, Wukich DK. End-Stage Renal Disease Negatively Affects Physical Quality of Life in Patients With Diabetic Foot Complications. INT J LOW EXTR WOUND 2017; 16:135-142. [PMID: 28682731 DOI: 10.1177/1534734617707081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of this study was to evaluate the impact of end-stage renal disease (ESRD) on health-related quality of life (QOL) in patients with diabetic foot disease. We compared a group of 30 diabetic patients with ESRD requiring dialysis to a group of 60 diabetic patients without ESRD. Both groups consisted of patients with active diabetic foot disease (ulcer, Charcot, infection) and were matched with regard to age and gender. Self-reported QOL was assessed using the Short Form-36 (SF-36) physical and mental component summary (PCS and MCS) scores and the region-specific Foot and Ankle Ability Measure (FAAM). Diabetic foot patients with ESRD requiring dialysis were found to have significantly higher creatinine levels, lower hemoglobin levels, lower albumin levels, higher rates of peripheral arterial disease, and lower rates of Charcot neuroarthropathy than patients without ESRD. The median PCS was significantly lower in the ESRD group; however, no significant difference was found when comparing the median MCS and FAAM. Patients who ultimately died had a tendency to report lower PCS scores at baseline compared with those patients who did not die ( P = .07). Patients who ultimately required major amputation also reported lower PCS scores at baseline. ESRD negatively affects physical QOL to a greater degree than mental QOL in patients with diabetic foot disease. The SF-36 may not be sensitive enough to capture impaired mental QOL because both groups had relatively high MCS scores. Low physical QOL may be associated with mortality and the eventual need for major amputation.
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Affiliation(s)
| | - Junho Ahn
- 2 University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Larry A Lavery
- 2 University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dane K Wukich
- 2 University of Texas Southwestern Medical Center, Dallas, TX, USA
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38
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Müllerova H, Gelhorn H, Wilson H, Benson VS, Karlsson N, Menjoge S, Rennard SI, Tabberer M, Tal-Singer R, Merrill D, Jones PW. St George's Respiratory Questionnaire Score Predicts Outcomes in Patients with COPD: Analysis of Individual Patient Data in the COPD Biomarkers Qualification Consortium Database. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2017; 4:141-149. [PMID: 28848923 DOI: 10.15326/jcopdf.4.2.2017.0131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: We aimed to estimate the usefulness of a disease specific health status measure, the St George's Respiratory Questionnaire (SGRQ), to predict outcomes in patients with chronic obstructive pulmonary disease (COPD). Methods: Individual patient-data of 12043 patients from long-term randomized clinical trials (2-4 years' duration) in the COPD Biomarkers Qualification Consortium database were analyzed. The adverse COPD outcomes were: exacerbations of COPD, hospital admissions due to exacerbation and all-cause mortality. Cox proportional hazards regression was used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for quartiles of SGRQ scores at baseline and time to first event, and time from first to second event, where appropriate. Results: The risk of adverse COPD outcomes increased with each increasing quartile of SGRQ score for all time to first event analyses. When comparing the lowest versus the highest quartile, the event risk (HRs [95% CIs]) increased by 40% for exacerbations (1.40 [1.29, 1.51]); 2-fold for hospital admissions (2.01 [1.78, 2.28]) and more than 2-fold for all-cause mortality (2.30 [1.91, 2.78]). For second event analyses in a subset of eligible patients, these trends persisted albeit with reduced risk estimates for exacerbations. Conclusions: Among patients with COPD, health status measured by a SGRQ score predicted exacerbations of COPD, hospital admissions due to exacerbations and their recurrence and death after adjustment. These data support the rationale for a health status measure use as a drug development tool and suggest that a health status measure may also have a role in risk assessment for COPD patients in routine medical care.
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Affiliation(s)
- Hana Müllerova
- Research and Development, GlaxoSmithKline, Uxbridge, United Kingdom
| | | | | | | | | | | | - Stephen I Rennard
- Division of Pulmonary, Critical Care, Sleep and Allergy, Nebraska Medical Center, Omaha.,AstraZeneca, Cambridge, United Kingdom
| | - Maggie Tabberer
- Research and Development, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Ruth Tal-Singer
- Respiratory Therapy Area Unit, Research and Development, GlaxoSmithKline, King of Prussia, Pennsylvania
| | | | - Paul W Jones
- Research and Development, GlaxoSmithKline, Uxbridge, United Kingdom.,Institute of Infection and Immunity, St George's University of London, United Kingdom
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Pickwell K, Siersma V, Kars M, Apelqvist J, Bakker K, Edmonds M, Holstein P, Jirkovská A, Jude EB, Mauricio D, Piaggesi A, Reike H, Spraul M, Uccioli L, Urbancic V, van Acker K, van Baal J, Schaper N. Minor amputation does not negatively affect health-related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: An observational study. Diabetes Metab Res Rev 2017; 33. [PMID: 27792855 DOI: 10.1002/dmrr.2867] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 10/12/2016] [Accepted: 10/16/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is poor in patients with persistent diabetic foot ulcers and poor HRQoL predicts worse outcomes in these patients. Amputation is often considered a treatment failure, which is why conservative treatment is generally preferred over amputation. However, it is unclear whether minor amputation negatively affects HRQoL compared with conservative treatment in patients with diabetic foot ulcers. METHODS In the cohort of the multicenter, prospective, observational Eurodiale study, we determined difference in change of HRQoL measured by EQ-5D between patients with a diabetic foot ulcers that healed after conservative treatment (n = 676) and after minor amputation (n = 145). Propensity score was used to adjust for known confounders, attempting to overcome lack of randomization. RESULTS Baseline HRQoL was not significantly different between patients treated conservatively and undergoing minor amputation. In addition, there was no difference in the change of HRQoL between these groups. In patients who healed 6 to 12 months after the first visit, HRQoL on the anxiety/depression subscale even appeared to improve more in those who underwent minor amputation. CONCLUSIONS Minor amputation was not associated with a negative impact on HRQoL in patients with a diabetic foot ulcers. It may therefore not be considered treatment failure in terms of HRQoL but rather a viable treatment option. A randomized controlled trial is warranted to further examine the influence of minor amputations on health-related quality of life.
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Affiliation(s)
- K Pickwell
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - V Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Kars
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Apelqvist
- Department of Endocrinology, University of Malmö, Malmö, Sweden
| | - K Bakker
- IDF Consultative Section and International Working Group on the Diabetic Foot, Heemstede, the Netherlands
| | - M Edmonds
- Diabetic Department, Kings College Hospital, London, United Kingdom
| | - P Holstein
- Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - A Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - E B Jude
- Diabetes Centre, Tameside General Hospital, Ashton-under-Lyne, UK
| | - D Mauricio
- Department of Endocrinology and Nutrition, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - A Piaggesi
- Sezione Dipartimentale Piede Diabetico, Dipartimento di Area Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - H Reike
- Innere Abteilung, Mariannen Hospital, Werl, Germany
| | - M Spraul
- Mathias-Spital, Diabetic Department, Rheine, Germany
| | - L Uccioli
- Policlinico Tor Vergata, Department of Internal medicine, Rome, Italy
| | - V Urbancic
- Department of Endocrinology, University Medical Centre, Ljubljana, Slovenia
| | - K van Acker
- H Familie Ziekenhuis and Centre de Santé des Fagnes, Department of Endocrinology, Rumst and Chimay, Belgium
| | - J van Baal
- Department of Surgery, Twenteborg Ziekenhuis, Almelo, The Netherlands
| | - N Schaper
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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40
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Clokie M, Greenway AL, Harding K, Jones NJ, Vedhara K, Game F, Dhatariya KK. New horizons in the understanding of the causes and management of diabetic foot disease: report from the 2017 Diabetes UK Annual Professional Conference Symposium. Diabet Med 2017; 34:305-315. [PMID: 28029181 DOI: 10.1111/dme.13313] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 01/24/2023]
Abstract
Diabetes-related foot disease remains a common problem. For wounds, classic teaching recommends the treatment of any infection, offloading the wound and ensuring a good blood supply, as well as ensuring that the other modifiable risk factors are addressed and optimized. There remain, however, several questions about these and other aspects of the care of diabetes-related foot disease. Some of these questions are addressed in the present report; in particular, the impact of newer technologies in the identification of any organisms present in a wound, as well as the use of novel approaches to treat infections. The use of new remote sensing technology to identify people at risk of developing foot ulceration is also considered, in an attempt to allow early intervention and prevention of foot ulcers. The psychological impact of foot disease is often overlooked, but with an increasing number of publications on the subject, the cause-and-effect role that psychology plays in foot disease, such as ulcers and Charcot neuroarthropathy, is considered. Finally, because of heterogeneity in diabetic foot studies, comparing results is difficult. A recently published document focusing on ensuring a standardized way of reporting foot disease trials is discussed.
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Affiliation(s)
- M Clokie
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, Rhondda Cynon Taf
| | - A L Greenway
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, Rhondda Cynon Taf
| | - K Harding
- Medical School, Cardiff University, Heath Park, Cardiff, Rhondda Cynon Taf
| | - N J Jones
- Welsh Wound Innovation Centre, Rhodfa Marics, Ynysmaerdy, Rhondda Cynon Taf
| | - K Vedhara
- Department of Health Psychology, Division of Primary Care, Nottingham University, Nottingham, UK
| | - F Game
- Department of Diabetes, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - K K Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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41
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Nemcová J, Hlinková E, Farský I, Žiaková K, Jarošová D, Zeleníková R, Bužgová R, Janíková E, Zdzieblo K, Wiraszka G, Stepien R, Nowak-Starz G, Csernus M, Balogh Z. Quality of life in patients with diabetic foot ulcer in Visegrad countries. J Clin Nurs 2017; 26:1245-1256. [DOI: 10.1111/jocn.13508] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Jana Nemcová
- Jessenius Faculty of Medicine in Martin; Comenius University in Bratislava; Martin Slovak Republic
| | - Edita Hlinková
- Jessenius Faculty of Medicine in Martin; Comenius University in Bratislava; Martin Slovak Republic
| | - Ivan Farský
- Jessenius Faculty of Medicine in Martin; Comenius University in Bratislava; Martin Slovak Republic
| | - Katarína Žiaková
- Jessenius Faculty of Medicine in Martin; Comenius University in Bratislava; Martin Slovak Republic
| | - Darja Jarošová
- Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
| | | | - Radka Bužgová
- Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
| | - Eva Janíková
- Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
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42
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Karri VVSR, Kuppusamy G, Talluri SV, Mannemala SS, Kollipara R, Wadhwani AD, Mulukutla S, Raju KRS, Malayandi R. Curcumin loaded chitosan nanoparticles impregnated into collagen-alginate scaffolds for diabetic wound healing. Int J Biol Macromol 2016; 93:1519-1529. [DOI: 10.1016/j.ijbiomac.2016.05.038] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/08/2016] [Accepted: 05/10/2016] [Indexed: 12/20/2022]
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43
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Alabi O, Roos M, Landry G, Moneta G. Quality-of-life assessment as an outcomes measure in critical limb ischemia. J Vasc Surg 2016; 65:571-578. [PMID: 27876523 DOI: 10.1016/j.jvs.2016.08.097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
Abstract
Critical limb ischemia (CLI) is a diagnosis plagued by significant comorbidity and high mortality rates. Overall survival remains poor in this population regardless of the procedure-related success as demonstrated by freedom from amputation, intervention, and patency. The literature has traditionally focused on physician-centered and lesion-centered outcomes with regards to limb salvage procedures, but there remains a relative paucity of studies of CLI patients describing patient-centered outcomes such as quality of life (QoL), independent living, and ambulation status. Review of the available literature indicates patients do not always experience significant gains in their QoL after limb salvage interventions, despite reasonable graft patency, amputation-free survival, and limb salvage rates. Further research is required using QoL tools in a measurable and clinically relevant fashion to guide optimal quality care that maximizes patient-centered outcomes.
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Affiliation(s)
- Olamide Alabi
- Division of Vascular and Endovascular Surgery, Oregon Health & Science University, Portland, Ore.
| | - Matthew Roos
- Division of Vascular and Endovascular Surgery, Oregon Health & Science University, Portland, Ore
| | - Gregory Landry
- Division of Vascular and Endovascular Surgery, Oregon Health & Science University, Portland, Ore
| | - Gregory Moneta
- Division of Vascular and Endovascular Surgery, Oregon Health & Science University, Portland, Ore
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44
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Quality of Life in Portuguese Patients with Diabetic Foot Ulcer Before and After an Amputation Surgery. Int J Behav Med 2016; 23:714-721. [DOI: 10.1007/s12529-016-9567-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Spanos K, Saleptsis V, Athanasoulas A, Karathanos C, Bargiota A, Chan P, Giannoukas AD. Factors Associated With Ulcer Healing and Quality of Life in Patients With Diabetic Foot Ulcer. Angiology 2016; 68:242-250. [PMID: 27225697 DOI: 10.1177/0003319716651166] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A prospective nonrandomized cohort study on consecutive diabetic patients with foot ulcer was undertaken to assess the factors associated with the healing process or limb salvage and evaluate the impact of their treatment on their quality of life. Quality of life was evaluated using Diabetic Foot Ulcer Scale-Short Form (DFS-SF) questionnaire before and after treatment. A total of 103 diabetic patients with ulcer (mean age 69.7 ± 9.6 years, 77% male) were treated and followed up for 12 months. Ulcer healing, minor amputation, and major amputation rates were 41%, 41%, and 18%, respectively, while the mortality rate was 18%. Ulcer healing was associated with University of Texas wound grade 1 and the Study of Infections in Diabetic feet comparing Efficacy, Safety and Tolerability of Ertapenem versus Piperacillin/Tazobactam trial's diabetic foot infection wound score. Limb loss was associated with nonpalpable popliteal artery, longer in-hospital stay, and delay until referral. Quality of life was improved in all domains of DFS-SF ( P < .0001) throughout the cohort of our patients regardless of their outcome, and no outcome (healing, minor amputation, or major amputation) was superior to other. Significant improvement was observed in all domains of hygiene self-management after consultation during the follow-up period.
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Affiliation(s)
- Konstantinos Spanos
- 1 Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vasileios Saleptsis
- 1 Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios Athanasoulas
- 1 Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Karathanos
- 1 Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Alexandra Bargiota
- 2 Department of Endocrinology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Philip Chan
- 3 Department of Vascular Surgery, Sheffield Vascular Institute, Northern General Hospital, Sheffield, United Kingdom
| | - Athanasios D Giannoukas
- 1 Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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46
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Soares JMD, Silva JC, Almeida JRGS, Quintans J uacute nior LJ, de OHP. Electrospun fibers for wound healing and treatment of hyperglycemia: A review. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/ajb2016.15350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Roehrs H, Stocco JGD, Pott F, Blanc G, Crozeta K, Meier MJ, Dias FAL. Dressings and topical agents containing hyaluronic acid for chronic wound healing. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hellen Roehrs
- Federal University of Paraná; Department of Nursing; Av. Lothario Meissner, 632 bloco Didático II Curitiba Paraná/Brazil Brazil 80210-170
| | - Janislei GD Stocco
- Clinical Hospital of Federal University of Paraná; Hospital Infection Control & Prevention; Av. Iguaçu, 2420 apto 32C, Agua Verde Curitiba Paraná Brazil 80240-030
| | - Franciele Pott
- Hospital Polícia Militar do Paraná; Department of Primary Care and Emergency; avenida Jão Fraga Neto 4906 jão jose dos Pinhais São José dos Pinhais Paraná Brazil 83060-540
| | - Gisely Blanc
- Prefeitura de São José dos Pinhais; Department of Primary Care and Emergency; João dembinski, 1003 Campo Comprido Curitiba Paraná Brazil 81270-330
| | - Karla Crozeta
- Federal University of Paraná; Department of Nursing; Av. Lothario Meissner, 632 bloco Didático II Curitiba Paraná/Brazil Brazil 80210-170
| | - Marineli J Meier
- Universidade Federal do Paraná; Department of Nursing and Program Postgraduation in Nursing; Av. Lothário Meissner, 632 Jardim Botânico Setor de Ciências da Saúde (Bloco Didático II - Campus Botânico) Curitiba Paraná Brazil 80.210-170
| | - Fernando AL Dias
- Federal University of Paraná; Department of Physiology; Centro Politécnico, Jardim das Américas Caixa Postal 19031 Curitiba Paraná Brazil 81531-980
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Katsanos K, Spiliopoulos S, Diamantopoulos A, Siablis D, Karnabatidis D, Scheinert D. Wound Healing Outcomes and Health-Related Quality-of-Life Changes in the ACHILLES Trial: 1-Year Results From a Prospective Randomized Controlled Trial of Infrapopliteal Balloon Angioplasty Versus Sirolimus-Eluting Stenting in Patients With Ischemic Peripheral Arterial Disease. JACC Cardiovasc Interv 2016; 9:259-267. [PMID: 26777329 DOI: 10.1016/j.jcin.2015.10.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The authors sought to report the wound healing outcomes, health-related quality-of-life changes and quality-adjusted life-years (QALYs) gain in the 2 treatment arms of the ACHILLES (Comparing Angioplasty and DES in the Treatment of Subjects With Ischemic Infrapopliteal Arterial Disease) multicenter randomized trial. BACKGROUND The ACHILLES randomized trial has previously shown that sirolimus-eluting stents (SES) may achieve lower vessel restenosis and higher event-free survival rates compared with plain balloon angioplasty (PTA) for infrapopliteal lesions. METHODS A total of 200 patients were randomly assigned between SES and PTA for the treatment of infrapopliteal arterial occlusive lesions. Progression of wound healing was serially assessed by digital photography. Health-related quality-of-life scores were assessed with the self-administered EQ-5D questionnaire up to 1 year from randomization. QALYs gained were calculated with a standard multiplicative model using distribution-free Bayesian modeling. RESULTS In total, 109 open wounds (n = 54 in SES; n = 55 in PTA) were documented at baseline. At 6 months, wound volume reduction (%) was significantly higher in the SES group (95% healing [95% confidence interval (CI): 80% to 99%] compared with 60% healing [95% CI: 13% to 90%] in the PTA group; p = 0.048). At 1 year, rates of complete wound closure were higher in the case of SES (72.9% vs. 55.6% closed wounds in PTA; p = 0.088). The recorded weighted EQ-5D score improved significantly up to 1 year in case of SES (p < 0.0001), but not in case of PTA. There was a trend of more QALYs gained with SES compared with PTA up to 1 year after randomization. Relative QALY gain was 0.10 (95% CI: -0.01 to 0.21; p = 0.08) in the whole study and 0.17 (95% CI: -0.03 to 0.35; p = 0.09) in the wound subgroups comparison. CONCLUSIONS Infrapopliteal SES accelerates wound healing and may improve quality of life compared with PTA. (Comparing Angioplasty and DES in the Treatment of Subjects With Ischemic Infrapopliteal Arterial Disease [ACHILLES]; NCT00640770).
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Affiliation(s)
- Konstantinos Katsanos
- Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, United Kingdom; Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece.
| | - Stavros Spiliopoulos
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Dimitris Siablis
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece
| | - Dimitris Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece
| | - Dierk Scheinert
- Department of Angiology, Park Hospital and Universitätsklinikum, Leipzig, Germany
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Sekhar MS, Thomas RR, Unnikrishnan MK, Vijayanarayana K, Rodrigues GS. Impact of diabetic foot ulcer on health-related quality of life: A cross-sectional study. Semin Vasc Surg 2015; 28:165-71. [PMID: 27113283 DOI: 10.1053/j.semvascsurg.2015.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Studies have reported that health-related quality of life (HRQoL) is adversely affected by diabetic foot ulcer (DFU). There is a paucity of data on the effects of foot ulcers on HRQoL of diabetes patients in our population. Because South-Asians, especially Indians, have unique features related to diabetes and its complications, generalizing the data about their effect on HRQoL from any other part of the world is not a pragmatic approach. This study evaluated the impact of foot ulcers on HRQoL of diabetes patients. This cross-sectional study, conducted in Kasturba Hospital, Manipal (coastal South India), included 200 DFU patients in a study group (SG) and 200 diabetes patients in a control group (CG). The RAND-36 questionnaire was employed for evaluating HRQoL scores for the patients in both groups. DFU patients also completed the Diabetic Foot Ulcer Scale-Short Form questionnaire. Independent t-test was used to test the differences in mean scores. Results found that both CG and SG have "poor" HRQoL (mean score <50) on all the subscales except for two in CG. There is a statistically significant difference between groups (P < 0.05) on all eight of the subscales of HRQoL. For both CG and SG, the Physical Component Summary domain score (44.9 ± 6.3 v 28.4 ± 3.4) and Mental Component Summary domain score (42.5 ± 3.8 v 29.5 ± 7.1) were poor. There were significant differences between CG and SG for both mean Physical Component Summary score and Mental Component Summary score of HRQoL (p < 0.05). The Diabetic Foot Ulcer Scale-Short Form found that HRQoL is very poor for DFU patients on all six domains. The study concludes that DFU patients have very poor HRQoL compared with diabetic patients. Likewise, the diabetic foot is associated with severely impaired HRQoL in both physical and mental health aspects. This study will help to develop a patient education model for DFU patients by looking at the various HRQoL domains that are adversely affected by the presence of foot ulcer.
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Affiliation(s)
- M Sonal Sekhar
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India 576104.
| | - Roy Raymol Thomas
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India 576104
| | - M K Unnikrishnan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India 576104
| | - K Vijayanarayana
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India 576104
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50
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Lipsky BA, Apelqvist J, Bakker K, van Netten JJ, Schaper NC. Diabetic foot disease: moving from roadmap to journey. Lancet Diabetes Endocrinol 2015; 3:674-5. [PMID: 26251212 DOI: 10.1016/s2213-8587(15)00252-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Benjamin A Lipsky
- Division of Medical Sciences, Green Templeton College, University of Oxford, Oxford, UK.
| | - Jan Apelqvist
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden; Division for Clinical Sciences University of Lund, Malmö, Sweden
| | - Karel Bakker
- International Working Group on the Diabetic Foot, Heemsteedse Dreef 90, 2102 KN, Heemstede, the Netherlands
| | - Jaap J van Netten
- Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Division Endocrinology, Maastricht University Hospital, Research Schools CARIM and CAPHRI, Maastricht, The Netherlands
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