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Natarajan J, Joseph MA, Alawi RA, Bulushi TA, Alawi IA, Junaibi SMA, Thanka AN, Balushi LDA, Ismaili ISA, Shumma M, Nabhani SSTA. Wellbeing, quality of life and satisfaction of patients with hard-to-heal wounds: a descriptive study. J Wound Care 2024; 33:526-532. [PMID: 38967342 DOI: 10.12968/jowc.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
OBJECTIVE A hard-to-heal wound is defined as a wound that failed to proceed through the normal phases of wound healing in an orderly and timely manner. The purpose of this article is to describe the impact of hard-to-heal wounds on the wellbeing, quality of life (QoL) and satisfaction with QoL of patients in Oman with hard-to-heal wounds. METHOD A descriptive cross-sectional study of patients with hard-to-heal wounds attending three tertiary care hospitals using a self-reported questionnaire was conducted. RESULTS A total of 275 patients took part in the study. Patients reported a low wellbeing score (67.06±19.72), moderate QoL score (52.18±25.07) and moderate satisfaction scores (68.91±23.88). Significant mean differences were reported with age, sex, educational level, monthly income and type of wound all at p<0.05. CONCLUSION The findings of this study demonstrated that hard-to-heal wounds could influence the wellbeing, QoL and overall satisfaction with QoL of patients. DECLARATION OF INTEREST Funding was received through an internal grant of the Sultan Qaboos University to conduct the research conducting the research (IG/CON/FACN/20/01). The authors have no conflicts of interest to declare.
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Affiliation(s)
- Jansirani Natarajan
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mickael Antoine Joseph
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Rashid Al Alawi
- Surgery Department, Royal Hospital, Muscat, Sultanate of Oman
| | - Taimoor Al Bulushi
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
| | | | - Suad Moosa Al Junaibi
- Adult Health Nursing Department, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - Anitha Nesa Thanka
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | | | - Moath Shumma
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
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Saura Cardoso V, de Souza Lima da Silveira PR, Dos Santos CM, Miranda MB, Silva Barros AC, Veloso LC, Magalhães AT, da Rocha RB, Hazime FA. Dose-response and efficacy of 904 nm photobiomodulation on diabetic foot ulcers healing: a randomized controlled trial. Lasers Med Sci 2024; 39:142. [PMID: 38805069 DOI: 10.1007/s10103-024-04090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/18/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE This study aimed to examine the impact of a 904 nm photobiomodulation (PBM) on diabetic ulcers using varying dosages. METHODS The study was a randomized, double-blind, placebo-controlled clinical trial that compared treatments using PBM (GaAs 904 nm 30w) with three different energy densities (4 J/cm2; 8 J/cm2; 10 J/cm2) in the healing process of non-infected diabetic foot ulcers. Eighty volunteers (48.75% female; 58.5 ± 11.1 years) were randomized into three intervention groups treated with PBM and one control group (PBM placebo). Volunteers performed up 20 interventions with PBM, either placebo or actual, in conjunction with conventional therapy, which involved dressing the wound with Helianthus annuus vegetable oil. The primary variable was the ulcer size reduction rate. RESULTS GaAs 904 nm PBM yielded a clinically and significant ulcer size rate reduction of diabetic foot ulcers, independently of energy density range (p < 0.05). However, 10 J/cm² had 60% of completely healed ulcers and the highest proportion of patients reaching 50% of ulcer reduction rate after 5 weeks of treatment. In addition, only 10 J/cm² showed a significant difference between control group after a 10-week follow-up (p < 0.05). CONCLUSION GaAs 904 nm PBM was effective in treating diabetic foot ulcers in this study and a dosage of 10 J/cm², after a 10-week follow-up, proved to be the most effective compared to the other groups. CLINICAL TRIAL REGISTRATION NUMBER NCT04246814.
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Affiliation(s)
- Vinicius Saura Cardoso
- Center of Medical Specialties, Parnaíba, Piauí, Brazil.
- Postgraduate program in Biomedical Sciences, Parnaíba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil.
- Biosignal Laboratory, School of Physical Therapy, Parnaíba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil.
| | - Pedro Renan de Souza Lima da Silveira
- Center of Medical Specialties, Parnaíba, Piauí, Brazil
- Postgraduate program in Biomedical Sciences, Parnaíba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | - Cristiana Maria Dos Santos
- Center of Medical Specialties, Parnaíba, Piauí, Brazil
- Postgraduate program in Biomedical Sciences, Parnaíba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | - Mariana Bezerra Miranda
- Center of Medical Specialties, Parnaíba, Piauí, Brazil
- Postgraduate program in Biomedical Sciences, Parnaíba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | - Ana Carolina Silva Barros
- Center of Medical Specialties, Parnaíba, Piauí, Brazil
- Biosignal Laboratory, School of Physical Therapy, Parnaíba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | - Lorena Coelho Veloso
- Center of Medical Specialties, Parnaíba, Piauí, Brazil
- Biosignal Laboratory, School of Physical Therapy, Parnaíba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | - Alessandra Tanuri Magalhães
- Center of Medical Specialties, Parnaíba, Piauí, Brazil
- Biosignal Laboratory, School of Physical Therapy, Parnaíba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
| | | | - Fuad Ahmad Hazime
- Postgraduate program in Biomedical Sciences, Parnaíba Delta Federal University (UFDPar), Parnaíba, Piauí, Brazil
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Butt MD, Ong SC, Rafiq A, Kalam MN, Sajjad A, Abdullah M, Malik T, Yaseen F, Babar ZUD. A systematic review of the economic burden of diabetes mellitus: contrasting perspectives from high and low middle-income countries. J Pharm Policy Pract 2024; 17:2322107. [PMID: 38650677 PMCID: PMC11034455 DOI: 10.1080/20523211.2024.2322107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Introduction Diabetes increases preventative sickness and costs healthcare and productivity. Type 2 diabetes and macrovascular disease consequences cause most diabetes-related costs. Type 2 diabetes greatly costs healthcare institutions, reducing economic productivity and efficiency. This cost of illness (COI) analysis examines the direct and indirect costs of treating and managing type 1 and type 2 diabetes mellitus. Methodology According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane, PubMed, Embase, CINAHL, Scopus, Medline Plus, and CENTRAL were searched for relevant articles on type 1 and type 2 diabetes illness costs. The inquiry returned 873 2011-2023 academic articles. The study included 42 papers after an abstract evaluation of 547 papers. Results Most articles originated in Asia and Europe, primarily on type 2 diabetes. The annual cost per patient ranged from USD87 to USD9,581. Prevalence-based cost estimates ranged from less than USD470 to more than USD3475, whereas annual pharmaceutical prices ranged from USD40 to more than USD450, with insulin exhibiting the greatest disparity. Care for complications was generally costly, although costs varied significantly by country and problem type. Discussion This study revealed substantial heterogeneity in diabetes treatment costs; some could be reduced by improving data collection, analysis, and reporting procedures. Diabetes is an expensive disease to treat in low- and middle-income countries, and attaining Universal Health Coverage should be a priority for the global health community.
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Affiliation(s)
- Muhammad Daoud Butt
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM, Penang, Malaysia
- Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM, Penang, Malaysia
| | - Azra Rafiq
- Department of Biological Sciences, Middle East Technical University, Ankara, Turkey
- Department of Pharmacy, Riphah International University, Lahore, Pakistan
| | - Muhammad Nasir Kalam
- Department of Pharmacy, The Sahara University, Narowal, Pakistan
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Ahsan Sajjad
- Ibn Sina Community Clinic, South Wilcrest Drive, Houston, Texas, USA
| | - Muhammad Abdullah
- Department of Pharmacy, Punjab University College of Pharmacy, Lahore, Pakistan
| | - Tooba Malik
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Fatima Yaseen
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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Hashempour R, MirHashemi S, Mollajafari F, Damiri S, ArabAhmadi A, Raei B. Economic burden of diabetic foot ulcer: a case of Iran. BMC Health Serv Res 2024; 24:363. [PMID: 38515182 PMCID: PMC10958898 DOI: 10.1186/s12913-024-10873-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 03/15/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is known as a serious complication of diabetes mellitus in patients with diabetes, imposing heavy medical costs on healthcare systems due to its chronic nature. patients with severe diabetic foot ulcer are often disabled to work, and some of them may even die, leading to associated productivity losses. Since no previous study has investigated the economic burden of DFU in Iran, this study is to estimate the economic burden of diabetic foot disease in Iran. METHODS In this descriptive cross-sectional study, randomly selected samples consisted of 542 patients with DFU, hospitalized in the hospitals of Shahid Beheshti University of Medical Sciences. The demographic profile and cost data used in this analysis were derived from a researcher-designed checklist. Lost productivity was calculated based on Human Capital Approach, and the total economic cost of DFU was determined using patient-level data on costs and prevalence data from the global burden of diseases reports. All analyses were performed using SPSS software (Version 23), and Microsoft Excel (Version 19). RESULTS The economic burden of DFU in Iran in two scenarios of discounting future costs and not discounting them was about $8.7 billion and $35 billion, respectively (about 0.59 and 2.41% of GDP). 79.25% of the estimated costs in this study were indirect costs and productivity losses, of which 99.34% (7,918.4 million Dollars) were productivity losses due to premature death. 20.75% (2,064.4 million dollars) of the estimated costs in this study were direct costs. The average length of stay (LOS) was 8.10 days (SD = 9.32), and 73.3% of patients recovered and were discharged after hospitalization and 7.6% died. The majority of the costs are imposed on the age group of 60-69 year (53.42% of the productivity lost due to hospital length of stay, 58.91% of the productivity lost due to premature death & 40.41% of direct costs). CONCLUSIONS DFU represents a heavy burden to patients, Iran's health system, and the economy. Early prevention strategies need to be prioritized in making public health policies. These policies and decisions can be in the area of changing lifestyle, health education, changing people's behavior, and encouraging physical activity that targeted high-risk populations in order to reduce the prevalence of diabetic foot and resulting substantial economic burden.
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Affiliation(s)
- Reza Hashempour
- Department of Health Economics and Statistics, Vice-Chancellor's Office in Treatment Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - SeyedHadi MirHashemi
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Mollajafari
- Department of Health Economics and Statistics, Vice-Chancellor's Office in Treatment Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Damiri
- Health Economics, Management, and Policy Department, Virtual School of Medical Education & Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali ArabAhmadi
- Department of Public Health, Qaen School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Behzad Raei
- Razi Educational and Therapeutic Center, Tabriz University of Medical Science, Tabriz, Iran.
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Garces TS, de Araújo AL, Sousa GJB, Cestari VRF, Florêncio RS, Mattos SM, Damasceno LLV, Santiago JCDS, Pessoa VLMDP, Pereira MLD, Moreira TMM. Clinical decision support systems for diabetic foot ulcers: a scoping review. Rev Esc Enferm USP 2024; 57:e20230218. [PMID: 38362842 PMCID: PMC10870364 DOI: 10.1590/1980-220x-reeusp-2023-0218en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/06/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE Map the scientific evidence on the use of clinical decision support systems in diabetic foot care. METHOD A scoping review based on the JBI Manual for Evidence Synthesis and registered on the Open Science Framework platform. Searches were carried out in primary and secondary sources on prototypes and computerized tools aimed at assisting patients with diabetic foot or at risk of having it, published in any language or period, in eleven databases and grey literature. RESULTS A total of 710 studies were identified and, following the eligibility criteria, 23 were selected, which portrayed the use of decision support systems in diabetic foot screening, predicting the risk of ulcers and amputations, classifying the stage of severity, deciding on the treatment plan, and evaluating the effectiveness of interventions, by processing data relating to clinical and sociodemographic information. CONCLUSION Expert systems stand out for their satisfactory results, with high precision and sensitivity when it comes to guiding and qualifying the decision-making process in diabetic foot prevention and care.
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Affiliation(s)
- Thiago Santos Garces
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Saúde
Coletiva, Fortaleza, CE, Brazil
| | - Açucena Leal de Araújo
- Universidade Estadual do Ceará, Programa de Pós-Graduação em
Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | | | - Virna Ribeiro Feitosa Cestari
- Universidade Estadual do Ceará, Programa de Pós-Graduação em
Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Raquel Sampaio Florêncio
- Universidade Estadual do Ceará, Programa de Pós-Graduação em
Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Samuel Miranda Mattos
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Saúde
Coletiva, Fortaleza, CE, Brazil
| | - Lara Lídia Ventura Damasceno
- Universidade Estadual do Ceará, Programa de Pós-Graduação em
Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | | | | | - Maria Lúcia Duarte Pereira
- Universidade Estadual do Ceará, Programa de Pós-Graduação em
Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Thereza Maria Magalhães Moreira
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Saúde
Coletiva, Fortaleza, CE, Brazil
- Universidade Estadual do Ceará, Programa de Pós-Graduação em
Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
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Queen D, Harding K. Estimating the cost of wounds both nationally and regionally within the top 10 highest spenders. Int Wound J 2024; 21:e14709. [PMID: 38379224 PMCID: PMC10830400 DOI: 10.1111/iwj.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 02/22/2024] Open
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Waibel FWA, Uçkay I, Soldevila-Boixader L, Sydler C, Gariani K. Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review. Front Endocrinol (Lausanne) 2024; 14:1323315. [PMID: 38298183 PMCID: PMC10829909 DOI: 10.3389/fendo.2023.1323315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Diabetes is a chronic disease associated with numerous complications including diabetic foot disorders, which are associated with significant morbidity and mortality as well as high costs. The costs associated with diabetic foot disorders comprise those linked to care (direct) and loss of productivity and poor quality of life (indirect). Due to the constant increase in diabetes prevalence, it is expected that diabetic foot disorder will require more resources, both in terms of caregivers and economically. We reviewed findings on management, morbidity, mortality, and costs related to diabetic foot disorder.
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Affiliation(s)
- Felix W. A. Waibel
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ilker Uçkay
- Infectiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Laura Soldevila-Boixader
- Infectious Diseases, Internal Medicine Department, Consorci Sanitari Integral-CSI, Sant Joan Despí Hospital, Barcelona, Spain
| | - Christina Sydler
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karim Gariani
- Service of Endocrinology, Diabetes, Nutrition, and Therapeutic Education, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Diabetes Center of the Faculty of Medicine, University of Geneva Medical School, Geneva, Switzerland
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Liu H, Ya‐Qing X, Cai‐Feng Y, Jia‐Li H, Xian‐Yu T. Diabetic foot wound ulcer management by laser therapy: A meta-analysis. Int Wound J 2023; 20:4208-4216. [PMID: 37596719 PMCID: PMC10681457 DOI: 10.1111/iwj.14320] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/20/2023] Open
Abstract
A meta-analysis examination was implemented to review diabetic foot wound ulcer (DFWU) management by laser therapy (LT). A broad literature examination until May 2023 was done and 1357 interconnected examinations were revised. The 26 elected examinations, enclosed 1067 personals with DFWU were in the utilized examinations 'starting point, 540 of them were utilizing LT, and 527 were utilizing control. Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the DFWUs management by LT by the dichotomous and continuous approach and a fixed or random model. LT had significantly higher ulcer size decreases (MD, 17.04; 95% CI, 12.48-21.59, p < 0.001) with high heterogeneity (I2 = 99%), and complete healing rate (OR, 2.88; 95% CI, 1.89-4.37, p < 0.001) with no heterogeneity (I2 = 0%) compared with control in personals with DFWU. LT had significantly higher ulcer size decreases, and complete healing rate compared to control in personals with DFWU. Nevertheless, exercise caution while interacting with its values since all the chosen examinations were found with a low sample size for the comparisons in the meta-analysis.
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Affiliation(s)
- He Liu
- Department of EndocrinologyGuangdong Provincial Hospital of Chinese MedicineGuangzhouChina
| | - Xia Ya‐Qing
- Department of EndocrinologyGuangdong Provincial Hospital of Chinese MedicineGuangzhouChina
| | - Yang Cai‐Feng
- Department of EndocrinologyGuangdong Provincial Hospital of Chinese MedicineGuangzhouChina
| | - He Jia‐Li
- Department of EndocrinologyGuangdong Provincial Hospital of Chinese MedicineGuangzhouChina
| | - Tang Xian‐Yu
- Department of EndocrinologyGuangdong Provincial Hospital of Chinese MedicineGuangzhouChina
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Yin Y, Wang L, Zhao L, Lin L, Shen X. Effect of 10.6 μm laser moxibustion on inflammation in diabetic peripheral neuropathy rats. Front Endocrinol (Lausanne) 2023; 14:1203677. [PMID: 37593350 PMCID: PMC10427917 DOI: 10.3389/fendo.2023.1203677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the main cause of disability in diabetes patients but the efficacy of available drugs is poor. Moxibustion is an adjunctive treatment for DPN that can reduce symptoms. The peak value of the far infrared wavelength of 10.6 μm laser moxibustion is close to the infrared radiation spectrum of traditional moxibustion. Its effect is similar to that of moxibustion and does not cause pain, infection or produce irritating smoke. Twenty-four male SD rats were divided into control (Con), DPN, laser moxibustion (LM), and pyrrolidine dithiocarbamate (PDTC) groups (n=6/group). The DPN, LM and PDTC group rats were intraperitoneally injected with 1% streptozotocin (STZ) to induce a model of DPN. LM group rats were irradiated with a laser at bilateral ST36 acupoints for 15 min, once every other day, for 14 days. PDTC group rats were intraperitoneally injected with PDTC once a day. Body weight, blood glucose, and paw withdrawal mechanical threshold (PWMT) were measured and laser speckle imaging (LSI) performed before and after modeling and at 1 and 2 weeks after intervention. Two weeks after intervention, changes in serum interleukin 1β (IL1β), interleukin 6 (IL6), tumor necrosis factor α (TNFα) and nerve growth factor (NGF) were analyzed, and the abundance of NF-κB and IκB-α proteins and levels of NF-κB and IκB-α mRNAs in the sciatic nerve were observed. The results showed that 10.6 μm laser moxibustion can relieve pain, improve microcirculation, and alleviate inflammation in DPN rats, possibly via the NF-κB inflammatory pathway.
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Affiliation(s)
- Yue Yin
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lina Wang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ling Zhao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin Lin
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xueyong Shen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Laboratory of Systemic Physiology for Acupuncture and Meridian, Shanghai Research Center of Acupuncture and Meridian, Shanghai, China
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Dahham J, Kremer I, Hiligsmann M, Hamdan K, Nassereddine A, Evers SMAA, Rizk R. Valuation of Costs in Health Economics During Financial and Economic Crises: A Case Study from Lebanon. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:31-38. [PMID: 36287378 PMCID: PMC9596339 DOI: 10.1007/s40258-022-00769-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 05/21/2023]
Abstract
In 2019, we embarked on a study on the economic burden of multiple sclerosis (MS) in Lebanon, in collaboration with a premier Lebanese MS center. This coincided with a triple disaster in Lebanon, comprising the drastic economic and financial crisis, the COVID-19 pandemic, and the consequences of the explosion of Beirut's port. Specifically, the economic and financial turmoil made the valuation of costs challenging. Researchers could face similar challenges, particularly in low- and middle-income countries (LMICs) where economic crises and recessions are recurrent phenomena. This paper aims to discuss steps taken to overcome the fluctuation of the prices of resources to get a valid valuation of societal costs during times of a financial and economic crisis. In the absence of local costing data and guidelines for conducting cost-of-illness (COI) studies, this paper provides empirical recommendations on the valuation of costs that are particularly relevant in LMICs. We recommend (1) clear reporting and justification of the country-specific context, year of costing, assumptions, data sources, and valuation methods, as well as the indicators used to adjust cost for inflation during different periods of fluctuation of prices; (2) collecting prices of each resource from multiple and various sources; (3) conducting a sensitivity analysis; and (4) reporting costs in local currency and Purchasing Power Parity dollars (PPP$). Precision and transparency in reporting prices of resources and their sources are markers of the reliability of the COI studies.
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Affiliation(s)
- Jalal Dahham
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Ingrid Kremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Kamal Hamdan
- Consultation and Research Institute, Beirut, Lebanon
| | | | - Silvia M. A. A. Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Centre for Economic Evaluations and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
| | - Rana Rizk
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie (INSPECT-Lb), Beirut, Lebanon
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Rastreamento de risco de ulceração nos pés em participantes de campanhas de prevenção e detecção do diabetes mellitus. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao02867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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12
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Batista JSJL, Bassetti BR, Kaiser TDL, Vicente CR, Schuenck RP. Impact of microbiological characteristics on the costs of treating diabetic foot infection. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Spellberg B, Aggrey G, Brennan MB, Footer B, Forrest G, Hamilton F, Minejima E, Moore J, Ahn J, Angarone M, Centor RM, Cherabuddi K, Curran J, Davar K, Davis J, Dong MQ, Ghanem B, Hutcheon D, Jent P, Kang M, Lee R, McDonald EG, Morris AM, Reece R, Schwartz IS, So M, Tong S, Tucker C, Wald-Dickler N, Weinstein EJ, Williams R, Yen C, Zhou S, Lee TC. Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open 2022; 5:e2211321. [PMID: 35536578 PMCID: PMC9092201 DOI: 10.1001/jamanetworkopen.2022.11321] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. OBJECTIVE To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools. EVIDENCE REVIEW This consensus statement and systematic review study used a novel approach from the WikiGuidelines Group, an open access collaborative research project, to construct clinical guidelines for pyogenic osteomyelitis. In June 2021 and February 2022, authors recruited via social media conducted multiple PubMed literature searches, including all years and languages, regarding osteomyelitis management; criteria for article quality and inclusion were specified in the group's charter. The GRADE system for evaluating evidence was not used based on previously published concerns regarding the potential dissociation between strength of recommendation and quality of evidence. Instead, the charter required that clear recommendations be made only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were drafted to discuss pros and cons of care choices. Both clear recommendations and clinical reviews were planned with the intention to be regularly updated as new data become available. FINDINGS Sixty-three participants with diverse expertise from 8 countries developed the group's charter and its first guideline on pyogenic osteomyelitis. These participants included both nonacademic and academic physicians and pharmacists specializing in general internal medicine or hospital medicine, infectious diseases, orthopedic surgery, pharmacology, and medical microbiology. Of the 7 questions addressed in the guideline, 2 clear recommendations were offered for the use of oral antibiotic therapy and the duration of therapy. In addition, 5 clinical reviews were authored addressing diagnosis, approaches to osteomyelitis underlying a pressure ulcer, timing for the administration of empirical therapy, specific antimicrobial options (including empirical regimens, use of antimicrobials targeting resistant pathogens, the role of bone penetration, and the use of rifampin as adjunctive therapy), and the role of biomarkers and imaging to assess responses to therapy. CONCLUSIONS AND RELEVANCE The WikiGuidelines approach offers a novel methodology for clinical guideline development that precludes recommendations based on low-quality data or opinion. The primary limitation is the need for more rigorous clinical investigations, enabling additional clear recommendations for clinical questions currently unresolved by high-quality data.
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Affiliation(s)
- Brad Spellberg
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Gloria Aggrey
- Montgomery Medical Associates PC, Rockville, Maryland
| | - Meghan B. Brennan
- University of Wisconsin Hospital and Clinics, William S. Middleton Memorial Veterans Hospital, Madison
| | - Brent Footer
- Providence Portland Medical Center, Portland, Oregon
| | | | | | - Emi Minejima
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
- Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles
| | - Jessica Moore
- Providence Little Company of Mary Medical Center, San Pedro, California
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor
| | | | - Robert M. Centor
- Department of Medicine, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Alabama
| | | | - Jennifer Curran
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor
| | - Kusha Davar
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Joshua Davis
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Mei Qin Dong
- New York Health and Hospitals Bellevue Hospital, New York, New York
| | | | - Doug Hutcheon
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Philipp Jent
- Department of Infectious Diseases, Inselspital Bern University Hospital, Bern, Switzerland
| | - Minji Kang
- University of Texas Southwestern, Dallas
| | - Rachael Lee
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham
| | - Emily G. McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Canada
| | - Andrew M. Morris
- Department of Medicine, Division of Infectious Diseases, Sinai Health, University Health Network, and University of Toronto, Toronto, Canada
| | - Rebecca Reece
- Section of Infectious Diseases, Department of Medicine, West Virginia University School of Medicine, Morgantown
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Miranda So
- Sinai Health System-University Health Network Antimicrobial Stewardship Program, UHN and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Steven Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital and University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Christopher Tucker
- Hospital Medicine, Magnolia Regional Health Center, Corinth, Mississippi
| | - Noah Wald-Dickler
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Erica J. Weinstein
- Division of Infectious Diseases, Department of Medicine and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Riley Williams
- Pharmacy Service, Oklahoma City VA Health Care System, Oklahoma City, Oklahoma
| | | | - Shiwei Zhou
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor
| | - Todd C. Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Canada
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Menezes LGC, Guedes MVC, Oliveira SKPD, Rocha RM, Pinheiro AKB, Silva LDFD, Moura DDJM, Coelho MDMF. Production and validation of the short film Pés que te quero®: educational technology for people with diabetes. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To describe the production and validation of short film type educational technology for the prevention of diabetic foot ulcers. Methods: A methodological study focused on the validation of a short film. The construction of the film was carried out in three stages: pre-production, production, and post-production. Thirty-seven evaluators undertook the internal validation, divided into two groups of 31 proficient nurses and six from the communication area. Fifteen people with diabetes mellitus performed the external validation. Result: The nursing proficient validated the script with a total content validity index of 0.95, with internal reliability of 0.849 conferred by Cronbach’s Alpha. Communication specialists validated with a content validity index of 0.97; and target audience with 0.95 (clarity) and 0.97 (relevance). Conclusion: The study showed that the short film is a valid and reliable educational technology to promote foot care to people with diabetes mellitus.
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Menezes LGC, Guedes MVC, Oliveira SKPD, Rocha RM, Pinheiro AKB, Silva LDFD, Moura DDJM, Coelho MDMF. Production and validation of the short film Pés que te quero®: educational technology for people with diabetes. Rev Bras Enferm 2022; 75:e20210329. [DOI: 10.1590/0034-7167-2021-032920210329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/25/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To describe the production and validation of short film type educational technology for the prevention of diabetic foot ulcers. Methods: A methodological study focused on the validation of a short film. The construction of the film was carried out in three stages: pre-production, production, and post-production. Thirty-seven evaluators undertook the internal validation, divided into two groups of 31 proficient nurses and six from the communication area. Fifteen people with diabetes mellitus performed the external validation. Result: The nursing proficient validated the script with a total content validity index of 0.95, with internal reliability of 0.849 conferred by Cronbach’s Alpha. Communication specialists validated with a content validity index of 0.97; and target audience with 0.95 (clarity) and 0.97 (relevance). Conclusion: The study showed that the short film is a valid and reliable educational technology to promote foot care to people with diabetes mellitus.
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Ahmed MU, Tannous WK, Agho KE, Henshaw F, Turner D, Simmons D. Social determinants of diabetes-related foot disease among older adults in New South Wales, Australia: evidence from a population-based study. J Foot Ankle Res 2021; 14:65. [PMID: 34915904 PMCID: PMC8680161 DOI: 10.1186/s13047-021-00501-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetes-related foot is the largest burden to the health sector compared to other diabetes-related complications in Australia, including New South Wales (NSW). Understanding of social determinants of diabetes-related foot disease has not been definitive in Australian studies. This study aimed to investigate the social determinants of diabetes-related foot disease in NSW. METHODOLOGY The first wave of the 45 and Up Study survey data was linked with NSW Admitted Patient Data Collection, Emergency Department Data Collection, and Pharmaceutical Benefits Scheme data resulting in 28,210 individuals with diabetes aged 45 years and older in NSW, Australia. Three outcome variables were used: diabetes-related foot disease (DFD), diabetic foot ulcer (DFU), and diabetic foot infection (DFI). They were classified as binary, and survey logistic regression was used to determine the association between each outcome measure and associated factors after adjusting for sampling weights. RESULTS The prevalence of DFD, DFU and DFI were 10.8%, 5.4% and 5.2%, respectively, among people with diabetes. Multivariate analyses revealed that the common factors associated with DFD, DFU and DFI were older age (75 years or more), male, single status, background in English speaking countries, and coming from lower-income households (less than AUD 20,000 per year). Furthermore, common lifestyle and health factors associated with DFD, DFU, and DFI were low physical activity (< 150 min of moderate-to-vigorous physical activity per week), history of diabetes for over 15 years, and having cardiovascular disease. CONCLUSION Our study showed that about 1 in 10 adults with diabetes aged 45 years and older in NSW reported DFD. Interventions, including the provision of related health services aimed at reducing all forms of DFD in NSW, are recommended to target older individuals with a long history of diabetes, and coming from lower-income households.
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Affiliation(s)
- Moin Uddin Ahmed
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.
| | - Wadad Kathy Tannous
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- Department of Economics, Finance and Property, School of Business, Western Sydney University, Parramatta Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Kingsley Emwinyore Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Frances Henshaw
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- ConvaTec, Building 5, Brandon Business Park, 530 Springvale Rd, Glen Waverley, VIC, 3150, Australia
| | - Deborah Turner
- School of Clinical Sciences, Podiatric Medicine, Kelvin Grove Campus, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - David Simmons
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, 2560, Australia
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Bedriñana-Marañón B, Rubio-Rodríguez M, Yovera-Aldana M, Garcia-Villasante E, Pinedo-Torres I. Association Between the Diabetes mellitus Duration and the Severity of Diabetic Foot Disease in Hospitalized Patients in Latin America. INT J LOW EXTR WOUND 2021:15347346211063266. [PMID: 34889665 DOI: 10.1177/15347346211063266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective was to determine the association between a diabetes mellitus duration greater than 10 years and the severity of diabetic foot in hospitalized patients in Latin America.Analytical, observational, and retrospective study based in secondary databases. Patients older than 18 years with diagnosis of diabetes mellitus (DM) and hospitalized for any causes were included. The independent and dependent variables were having more than 10 years of diagnosis of DM and the severity of the diabetic foot disease (Wagner> = 2), respectively. A crude Poisson regression analysis was performed to obtain prevalence rates adjusted to confounders.Male gender was 54.8% and the median age was 62 years. In the group with more than10 years of disease (n = 903) 18% (n = 162) had severe injuries. We performed two Poisson regression analyzes, one of which included the entire sample; and in the other, only patients with some degree of ulcer were included at the time of evaluation (Wagner > = 1). In the first analysis the PR was 1.95 (p < 0.01) adjusted for the significant variables in the bivariate analysis and in the second analysis the PR was 1.18 (p < 0.01) adding to the adjustment the days of injury prior to hospitalization and the location of the ulcer.We conclude that in patients with more than 10 years of diabetes mellitus, diabetic foot injuries are more severe, regardless type of diabetes, gender, age, history of amputation and days of injury prior to hospitalization for inpatients in Latin America.
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Affiliation(s)
| | | | - Marlon Yovera-Aldana
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
- 33209Red de Eficacia Clinica y Sanitaria, REDECS, Lima, Perú
| | - Eilhart Garcia-Villasante
- 33209Red de Eficacia Clinica y Sanitaria, REDECS, Lima, Perú
- 269034Hospital Nacional Daniel Alcides Carrion, Callao, Perú
| | - Isabel Pinedo-Torres
- Grupo de Investigación Neurociencia, Efectividad y Salud Pública, Universidad Científica del Sur, Lima, Perú
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Santos CMD, Rocha RBD, Hazime FA, Cardoso VS. A Systematic Review and Meta-Analysis of the Effects of Low-Level Laser Therapy in the Treatment of Diabetic Foot Ulcers. INT J LOW EXTR WOUND 2021; 20:198-207. [PMID: 32394760 DOI: 10.1177/1534734620914439] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Diabetic foot ulcers (DFUs) are considered one of the most aggressive and expensive complications of diabetes. Low-level laser therapy (LLLT) has been highlighted as a potential modality of treatment to accelerate the healing of ulcers. This systematic review and meta-analysis aimed to investigate the efficacy of LLLT in the treatment of DFU and identify the LLLT application parameters recommended for the treatment of DFU over the past 10 years. A systematic search was conducted in PubMed, BVS, PEDro, Scopus, Web of Science, and CINAHL up to March 31, 2019. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, randomized controlled trials (RCTs) that assessed the effect of LLLT on the treatment of DFU were included. Thirteen RCTs with a total of 361 participants were included in this review. Three RCTs reported a reduction in the percentage size of the ulcers and were included in the meta-analysis. The meta-analysis of the percentage size difference demonstrated a significant reduction in ulcer size in the LLLT group compared with controls (22.96 [95% confidence interval = 18.22-27.69; z = 9.51, P < .0001]). Treatment with 632.8 to 685 nm, 50 mW/cm2, 3 to 6 J/cm2, and irradiation for 30 to 80 seconds, 3 times weekly for a month is of benefit to patients with DFU. LLLT is effective and safe for the treatment of DFU. Additionally, well-designed, high-quality studies are needed to allow its ideal parameterization for clinical practice.
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Carvalho MTB, Araújo-Filho HG, Barreto AS, Quintans-Júnior LJ, Quintans JSS, Barreto RSS. Wound healing properties of flavonoids: A systematic review highlighting the mechanisms of action. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 90:153636. [PMID: 34333340 DOI: 10.1016/j.phymed.2021.153636] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/22/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Flavonoids are a class of compounds with a wide variety of biological functions, being an important source of new products with pharmaceutical potential, including treatment of skin wounds. PURPOSE This review aimed to summarize and evaluate the evidence in the literature in respect of the healing properties of flavonoids on skin wounds in animal models. STUDY DESIGN This is a systematic review following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. METHODS This was carried out through a specialized search of four databases: PubMed, Scopus, Web of Science and Embase. The following keyword combinations were used: "flavonoidal" OR "flavonoid" OR "flavonoidic" OR "flavonoids" AND "wound healing" as well as MeSH terms, Emtree terms and free-text words. RESULTS Fifty-five (55) articles met the established inclusion and exclusion criteria. Flavonoids presented effects in respect of the inflammatory process, angiogenesis, re-epithelialization and oxidative stress. They were shown to be able to act on macrophages, fibroblasts and endothelial cells by mediating the release and expression of TGF-β1, VEGF, Ang, Tie, Smad 2 and 3, and IL-10. Moreover, they were able to reduce the release of inflammatory cytokines, NFκB, ROS and the M1 phenotype. Flavonoids acted by positively regulating MMPs 2, 8, 9 and 13, and the Ras/Raf/MEK/ERK, PI3K/Akt and NO pathways. CONCLUSION Flavonoids are useful tools in the development of therapies to treat skin lesions, and our review provides a scientific basis for future basic and translational research.
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Affiliation(s)
- Mikaella T B Carvalho
- Laboratory of Neuroscience and Pharmacological Assays (LANEF), Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, S/N, Rosa Elza, CEP: 49.000-100, São Cristóvão, SE, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Heitor G Araújo-Filho
- Laboratory of Neuroscience and Pharmacological Assays (LANEF), Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, S/N, Rosa Elza, CEP: 49.000-100, São Cristóvão, SE, Brazil
| | - André S Barreto
- Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, São Cristóvão, SE, Brazil; Laboratory Pharmacology Cardiovascular (LAFAC), Department of Physiology, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Lucindo J Quintans-Júnior
- Laboratory of Neuroscience and Pharmacological Assays (LANEF), Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, S/N, Rosa Elza, CEP: 49.000-100, São Cristóvão, SE, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Jullyana S S Quintans
- Laboratory of Neuroscience and Pharmacological Assays (LANEF), Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, S/N, Rosa Elza, CEP: 49.000-100, São Cristóvão, SE, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Rosana S S Barreto
- Laboratory of Neuroscience and Pharmacological Assays (LANEF), Department of Physiology, Federal University of Sergipe, Marechal Rondon Avenue, S/N, Rosa Elza, CEP: 49.000-100, São Cristóvão, SE, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, São Cristóvão, SE, Brazil.
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Lira JAC, Nogueira LT, Oliveira BMAD, Soares DDR, Santos AMRD, Araújo TMED. Factors associated with the risk of diabetic foot in patients with diabetes mellitus in Primary Care. Rev Esc Enferm USP 2021; 55:e03757. [PMID: 34320142 DOI: 10.1590/s1980-220x2020019503757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze factors associated with diabetic foot risk in patients with diabetes mellitus assisted in Primary Care. METHOD Observational, analytic, and transversal study took place in Teresina, Piauí, with diabetic patients who are assisted in Primary Care. Data collection took place through interviews, foot clinical exams, and medical record analysis. We used the Mann-Whitney, Pearson's Chi-square and multiple logistic regression statistics tests to analyze the data. The association power among categorical variables was measured by Odds Ratio . RESULTS 322 patients participated. Marital status with a partner presented a protection factor (p = 0.007). Risk factors for the development of the diabetic foot are: arterial hypertension (p = 0.045), obesity (p = 0.011), smoking (p = 0.027), not being submitted to follow ups (p = 0.046), inadequate control of capillary blood glucose (p < 0.001), indisposition to the care of the foot (p=0.014), and foot self-exam less frequently (p = 0.040). CONCLUSION Sociodemographic, clinical, and self-care aspects interfere in diabetic foot development, highlighting the necessity of effective follow up tracking and educational interventions for patients with diabetes mellitus in Primary Care.
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Alsabek MB, Abdul Aziz AR. Diabetic foot ulcer, the effect of resource-poor environments on healing time and direct cost: A cohort study during Syrian crisis. Int Wound J 2021; 19:531-537. [PMID: 34219380 PMCID: PMC8874114 DOI: 10.1111/iwj.13651] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/13/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
Diabetic foot ulcer (DFU) is one of the slowest healing wounds that hurt the human body. Many studies from developed countries are concerned about materials, procedures, and equipment that accelerate the healing time. In Sweden, the diabetic foot management costs around 24965$/patient. In this review, we would evaluate the healing time of DFUs during what is considered one of the worst humanitarian crisis of the 21st century. 1747 DFUs were studied from the main diabetic foot clinic in Damascus (2014-2019). We predicted many variables that could prolong the healing time. The cost according to these variables was also reported. The SINBAD Classification was performed to grade the severity of ulcers. We noticed that the median healing time for DFUs was 8 weeks. Almost half of these ulcers healed between 3 and 12 weeks. The time of healing for men was significantly longer than that for women. While the presence of infection doubled the median time of healing, the presence of peripheral artery disease doubled the mean of the direct health care cost. The location of the ulcer acted as another independent risk factor. In conclusion, DFUs face many barriers to heal during a crisis.The environment with resource-poor settings should be added to the traditional risk factors that delay the healing of DFUs for months or even years. More studies from disaster are as are needed to evaluate low-cost materials that could be cost effective in applying standard care of the diabetic foot.
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Affiliation(s)
- Mhd Belal Alsabek
- Al-Mouwassat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria.,Faculty of Medicine, Syrian Private University, Damascus, Syria
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Paixão JC, de Oliveira FR, Guimarães NS, Machado JAN, de Souza MRCP. MICRO-CONTROLLED THERMAL STIMULATOR FOR DETECTING FINE FIBER CHANGES IN PATIENTS WITH DIABETES MELLITUS: A DIAGNOSTIC ACCURACY STUDY. Prim Care Diabetes 2021; 15:548-553. [PMID: 33541822 DOI: 10.1016/j.pcd.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/27/2020] [Accepted: 01/09/2021] [Indexed: 11/22/2022]
Abstract
AIM To evaluate sensitivity and specificity of the micro-controlled thermal stimulator (MTS) for detecting pathological changes in fine fiber of neuropathy patients with DM. METHODS A diagnostic accuracy study including 84 patients, aged 15-75 years was conducted. A patient's foot was subjected to dermatological, musculoskeletal, vascular, and neurological evaluations. The latter was performed through the perception of a sharp touch with a toothpick (pinprick), thermal sensitivity (cold and hot temperature sensations measured using Diapason Handle and MTS, respectively), vibratory sensitivity (128 Hz Diapason Handle), 10 g Semmes-Weinstein monofilament, and a reflex test. Statistical analyses were performed using Stata® software version 13.0. The sensitivity, specificity, positive and negative predictive values, likelihood ratios, AUC, Kappa index, and accuracy of the diagnostic instruments were evaluated. RESULTS Of the 84 volunteers, 66.7% were female, with an average age of 54 years. We observed that 17% of the total patients were positive for pain sensations in the foot, 13% for cold-temperature sensations, and 21% for hot-temperature sensations. The MTS (hot temperature) obtained 97.6% sensitivity and 90% specificity, agreeing on 87.5% (Kappa index) with the Diapason Handle (cold temperature) (AUC > 0.937; p < 0.05). CONCLUSION MTS is an accurate, sensitive, and specific instrument for the evaluation of diabetic neuropathy as compared with the tuning fork as the standard method and, consequently, it could be of help for the early diagnosis of diabetic neuropathy.
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Santiago MAMT, Tarcia RML, Frederico GA, Vitorino LM, Parisi MCR, Gamba MA. Digital educational technology for care management of diabetes mellitus people's feet. Rev Bras Enferm 2021; 74Suppl 5:e20190725. [PMID: 33787769 DOI: 10.1590/0034-7167-2019-0725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 09/13/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to develop and validate a distance learning course aimed at the pillars of care management of diabetes mellitus people's feet. METHOD a technological production research using Moodle Virtual Learning Environment, based on Andragogy, Constructionism and Instructional Design. Content is based on consensus guidelines on diabetic foot. Validation was carried out by distance education, diabetes and/or diabetic foot experts. RESULTS the course's content is based on diabetic foot guidelines, and is structured in units with didactic material, videos, forums and questionnaires to assess the participants' learning. The judges considered it appropriate to meet nurses' needs in clinical practice. CONCLUSION the virtual learning course has been validated, being a promising strategy for training nurses on care management of diabetes mellitus people's feet.
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Borges PA, Waclawiak I, Georgii JL, Fraga-Junior VDS, Barros JF, Lemos FS, Russo-Abrahão T, Saraiva EM, Takiya CM, Coutinho-Silva R, Penido C, Mermelstein C, Meyer-Fernandes JR, Canto FB, Neves JS, Melo PA, Canetti C, Benjamim CF. Adenosine Diphosphate Improves Wound Healing in Diabetic Mice Through P2Y 12 Receptor Activation. Front Immunol 2021; 12:651740. [PMID: 33828561 PMCID: PMC8019717 DOI: 10.3389/fimmu.2021.651740] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/01/2021] [Indexed: 01/13/2023] Open
Abstract
Chronic wounds are a public health problem worldwide, especially those related to diabetes. Besides being an enormous burden to patients, it challenges wound care professionals and causes a great financial cost to health system. Considering the absence of effective treatments for chronic wounds, our aim was to better understand the pathophysiology of tissue repair in diabetes in order to find alternative strategies to accelerate wound healing. Nucleotides have been described as extracellular signaling molecules in different inflammatory processes, including tissue repair. Adenosine-5'-diphosphate (ADP) plays important roles in vascular and cellular response and is immediately released after tissue injury, mainly from platelets. However, despite the well described effect on platelet aggregation during inflammation and injury, little is known about the role of ADP on the multiple steps of tissue repair, particularly in skin wounds. Therefore, we used the full-thickness excisional wound model to evaluate the effect of local ADP application in wounds of diabetic mice. ADP accelerated cutaneous wound healing, improved new tissue formation, and increased both collagen deposition and transforming growth factor-β (TGF-β) production in the wound. These effects were mediated by P2Y12 receptor activation since they were inhibited by Clopidogrel (Clop) treatment, a P2Y12 receptor antagonist. Furthermore, P2Y1 receptor antagonist also blocked ADP-induced wound closure until day 7, suggesting its involvement early in repair process. Interestingly, ADP treatment increased the expression of P2Y12 and P2Y1 receptors in the wound. In parallel, ADP reduced reactive oxygen species (ROS) formation and tumor necrosis factor-α (TNF-α) levels, while increased IL-13 levels in the skin. Also, ADP increased the counts of neutrophils, eosinophils, mast cells, and gamma delta (γδ) T cells (Vγ4+ and Vγ5+ cells subtypes of γδ+ T cells), although reduced regulatory T (Tregs) cells in the lesion. In accordance, ADP increased fibroblast proliferation and migration, myofibroblast differentiation, and keratinocyte proliferation. In conclusion, we provide strong evidence that ADP acts as a pro-resolution mediator in diabetes-associated skin wounds and is a promising intervention target for this worldwide problem.
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Affiliation(s)
- Paula Alvarenga Borges
- Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Fluminense Federal Institute (IFF), Rio de Janeiro, Brazil
| | - Ingrid Waclawiak
- Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Janaína Lima Georgii
- Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Janaína Figueiredo Barros
- Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Felipe Simões Lemos
- Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Thaís Russo-Abrahão
- Institute of Medical Biochemistry Leopoldo de Meis, Center of Health Sciences, UFRJ, Rio de Janeiro, Brazil
| | - Elvira Maria Saraiva
- Institute of Microbiology Paulo de Góes, Center of Health Sciences, UFRJ, Rio de Janeiro, Brazil
| | - Christina M. Takiya
- Institute of Biophysics Carlos Chagas Filho (IBCCF), Center of Health Sciences, UFRJ, Rio de Janeiro, Brazil
| | - Robson Coutinho-Silva
- Institute of Biophysics Carlos Chagas Filho (IBCCF), Center of Health Sciences, UFRJ, Rio de Janeiro, Brazil
| | - Carmen Penido
- Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Laboratory of Applied Pharmacology, Institute of Drug Technology, Farmanguinhos, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Claudia Mermelstein
- Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Fábio B. Canto
- Department of Immunobiology, Institute of Biology, Fluminense Federal University (UFF), Niterói, Brazil
| | - Josiane Sabbadini Neves
- Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Paulo A. Melo
- Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Claudio Canetti
- Institute of Biophysics Carlos Chagas Filho (IBCCF), Center of Health Sciences, UFRJ, Rio de Janeiro, Brazil
| | - Claudia Farias Benjamim
- Institute of Biomedical Sciences, Center of Health Sciences, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Institute of Biophysics Carlos Chagas Filho (IBCCF), Center of Health Sciences, UFRJ, Rio de Janeiro, Brazil
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Coelho MDMF, Menezes LCGD, Oliveira SKPD, Bonfim ADAC, Cavalcante VMV, Moraes JT, Cabral RL. TAXA DE CICATRIZAÇÃO EM ÚLCERAS DO PÉ DIABÉTICO TRATADAS COM BIOMEMBRANA E HIDROCOLOIDE EM PÓ: ENSAIO CLÍNICO RANDOMIZADO. ESTIMA 2021. [DOI: 10.30886/estima.v19.986_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:avaliar taxa de cicatrização em úlceras do pé diabético tratadas com biomembrana de proteínas do látex de Calotropis procera (BioMem CpLP) quando comparada ao hidrocoloide em pó. Método: ensaio clínico randomizado controlado, registrado pelo Registro Brasileiro de Ensaio Clínico (REBEC), conforme protocolo RBR-98f3j9, realizado junto a oito pessoas com pé diabético, em ambulatório de pé diabético, de março a julho de 2019. No grupo experimental (n=04), realizou-se a aplicação de biomembrana; no grupo controle (n=04), utilizou-se o pó de hidrocoloide. A taxa de cicatrização foi avaliada com 30 e 60 dias após início do tratamento. Resultados: não se constataram diferenças estatísticas entre taxas de cicatrização do grupo controle e do grupo experimental na análise temporal dos 30 dias iniciais (p=0,726) e nos 60 dias subsequentes ao início do tratamento (p=0,562). Conclusão: a BioMem CpLP apresentou taxas de cicatrização semelhantes ao produto convencional, configurando-se como alternativa eficaz e de baixo custo para o tratamento de pés diabéticos.
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Coelho MDMF, Menezes LCGD, Oliveira SKPD, Bonfim ADAC, Cavalcante VMV, Moraes JT, Cabral RL. HEALING RATE IN DIABETIC FOOT ULCERS TREATED WITH BIOMEMBRANE AND HYDROCOLLOID POWDER: RANDOMIZED CLINICAL TRIAL. ESTIMA 2021. [DOI: 10.30886/estima.v19.986_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: to evaluate the rate of healing in diabetic foot ulcers treated with a biomembrane of latex proteins from Calotropis procera (BioMem CpLP) when compared to powdered hydrocolloid. Method: randomized controlled clinical trial, registered by the Brazilian Clinical Trial Registry (REBEC), according to protocol RBR-98f3j9, carried out with eight people with diabetic foot, in a diabetic foot clinic, from March to July 2019. In the experimental group (n = 04), biomembrane was applied; in the control group (n = 04), hydrocolloid powder was used. The healing rate was assessed at 30 and 60 days after starting treatment. Results: no statistical differences were found between the healing rates of the control group and the experimental group in the temporal analysis of the initial 30 days (p = 0.726) and in the 60 days following the start of treatment (p = 0.562). Conclusion: BioMem CpLP presented healing rates similar to the conventional product, being an effective and low cost alternative for the treatment of diabetic feet.
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Sima DI, Bondor CI, Vereşiu IA, Gâvan NA, Borzan CM. Hospitalization Costs of Lower Limb Ulcerations and Amputations in Patients with Diabetes in Romania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052230. [PMID: 33668243 PMCID: PMC7956777 DOI: 10.3390/ijerph18052230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/30/2022]
Abstract
In this retrospective case-control study conducted in Cluj-Napoca, Romania, we assessed the effect of ulcerations/amputations on hospitalization costs of patients with diabetes. Patients with (Group 1) or without (Group 2) ulcerations/amputations (case-control ratio 3:1) admitted to a single diabetes center between 2012–2017 were included. The effects of hospitalization days, age, duration of diabetes, body mass index and glycated hemoglobin (HbA1c) on total costs was explored using a multivariate linear regression analysis, enter model. Overall, 876 patients were included (Group 1: 682, 323 [47.4%] with amputations; Group 2: 194). Median (interquartile range) total expenses in Group 1 were 40% higher compared to Group 2 (€724 [504; 1186] vs €517 [362; 645], p < 0.001). Significant differences were observed between hospitalization costs (p < 0.001), cost of food (p < 0.001), medication (p = 0.044), drugs administered at the emergency room/intensive care unit (p < 0.001) and other expenses (p = 0.003). Hospitalization costs represented 80.5% of total expenses in Group 1 and 76.3% in Group 2. In multivariate analysis, hospitalization days influenced significantly the total costs in both groups (p < 0.001); in Group 2, the effect of HbA1c was also significant (p = 0.021). Diabetic foot ulcers and subsequent amputations most likely impose a significant economic burden on the Romanian public healthcare system.
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Affiliation(s)
- Diana I. Sima
- Department of Diabetes and Metabolic Diseases, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400006 Cluj Napoca, Romania
- Department of Public Health, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400083 Cluj Napoca, Romania
- Correspondence: ; Tel.: +40-264-414-566
| | - Cosmina I. Bondor
- Department of Medical Informatics and Biostatistics, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400349 Cluj Napoca, Romania
| | - Ioan A. Vereşiu
- Department of Diabetes and Metabolic Diseases, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400006 Cluj Napoca, Romania
- Podiatry Association, 400064 Cluj-Napoca, Romania
| | | | - Cristina M. Borzan
- Department of Public Health, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400083 Cluj Napoca, Romania
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Vogt TN, Koller FJ, Santos PND, Lenhani BE, Guimarães PRB, Kalinke LP. Quality of life assessment in chronic wound patients using the Wound-QoL and FLQA-Wk instruments. INVESTIGACION Y EDUCACION EN ENFERMERIA 2020; 38:e11. [PMID: 33306901 PMCID: PMC7885545 DOI: 10.17533/udea.iee.v38n3e11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate changes in the quality of life of patients with chronic wounds. METHODS Quantitative research with a cross-sectional design performed with 100 patients with chronic wounds from a university hospital and a Basic Health Unit in southern Brazil. The mean values of the domains of the instruments Wound Quality of Life (Wound-QoL) and Freiburg Life Quality Assessment Wound were compared with sociodemographic variables of age, sex and education. RESULTS The average age of the participants was 60.98 years old; 41% (n = 41) had diabetic ulcers and 83% (n = 83) treated the wounds for more than 24 months. The total quality of life value was below the mean with 37.50/100 with (Wound-QoL) and 44.20/100 with (FLQA-Wk). The variables of gender, and educational level were not correlated with either of the two instruments used to assess the quality of life. The age variable was significantly correlated with the satisfaction item of the FLQA-Wk. CONCLUSIONS The quality of life of patients with chronic wounds was considered poor. The age variable was correlated with the satisfaction domain, showing that the older the age, the lower the satisfaction. The use of instruments to evaluate the quality of life of patients with chronic wounds may help an effective treatment plan.
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Selvarajah D, Kar D, Khunti K, Davies MJ, Scott AR, Walker J, Tesfaye S. Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention. Lancet Diabetes Endocrinol 2019; 7:938-948. [PMID: 31624024 DOI: 10.1016/s2213-8587(19)30081-6] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of both type 1 and 2 diabetes. It is a leading cause of lower-limb amputation and disabling neuropathic pain. Amputations in patients with diabetes have a devastating effect on quality of life and are associated with an alarmingly low life expectancy (on average only 2 years from the amputation). Amputation also places a substantial financial burden on health-care systems and society in general. With the introduction of national diabetes eye screening programmes, the prevalence of blindness in working-age adults is falling. This is not the case, however, with diabetes related amputations. In this Review, we appraise innovative point-of-care devices that enable the early diagnosis of DPN and assess the evidence for early risk factor-based management strategies to reduce the incidence and slow the progression of DPN. We also propose a framework for screening and early multifactorial interventions as the best prospect for preventing or halting DPN and its devastating sequelae.
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Affiliation(s)
- Dinesh Selvarajah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | - Debasish Kar
- Derbyshire Community Health Services NHS Foundation Trust, Bakewell, UK; Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Adrian R Scott
- Academic Unit of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jeremy Walker
- Department of Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Solomon Tesfaye
- Academic Unit of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Rosa MFF, Guimarães SMF, Dominguez AGD, Assis RS, Reis CB, Rosa SDSRF. Desenvolvimento de tecnologia dura para tratamento do pé diabético: um estudo de caso na perspectiva da saúde coletiva. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Este é um estudo de caso que objetivou analisar, na perspectiva da saúde coletiva, o processo de desenvolvimento do equipamento médico para o tratamento do pé diabético realizado pela parceria entre o Ministério da Saúde (MS) e a Universidade de Brasília (UnB) no período de dezembro de 2016 a janeiro de 2019. A análise observou o comportamento do grupo de pesquisa responsável pela produção da tecnologia dura mediante as dificuldades em transformar a pesquisa em um produto com viés mercadológico capaz de ser assimilado na cobertura do Sistema Único de Saúde (SUS), concomitantemente à participação da saúde coletiva na superação de alguns entraves. Utilizou-se como estudo de caso a parceria entre o MS e a UnB apoiado no modelo de investigação qualitativa com ênfase em processos metodológicos de tipologia mista, mas com prioridade aos métodos de observação participante cuja unidade de análise está vinculada à saúde coletiva. Os resultados observados evidenciaram que a contribuição da saúde coletiva na produção da tecnologia dura minimizou lacunas para a provável transformação da ideia em produto assimilável pelo SUS. A participação da saúde coletiva diminuiu os espaços entre as áreas do conhecimento envolvidas, aproximando a universidade da iniciativa privada e dos órgãos reguladores.
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Epidemiology and Burden of Diabetic Foot Ulcer and Peripheral Arterial Disease in Korea. J Clin Med 2019; 8:jcm8050748. [PMID: 31130633 PMCID: PMC6571707 DOI: 10.3390/jcm8050748] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 01/13/2023] Open
Abstract
Information about the epidemiology of diabetic foot ulcer (DFU) with peripheral arterial disease (PAD) is likely to be crucial for predicting future disease progression and establishing a health care budget. We investigated the incidence and prevalence of DFU and PAD in Korea. In addition, we examined costs of treatments for DFU and PAD. This study was conducted using data from Health Insurance Review and Assessment Service from 1 January 2011 to 31 December 2016. The incidence of DFU with PAD was 0.58% in 2012 and 0.49% in 2016. The prevalence of DFU with PAD was 1.7% in 2011 to 1.8% in 2016. The annual amputation rate of DFU with PAD was 0.95% in 2012 and 1.10% in 2016. Major amputation was decreased, while minor amputation was increased. The direct cost of each group was increased, especially the limb saving group. which was increased from 296 million dollars in 2011 to 441 million dollars in 2016. The overall incidence of DFU with PAD was about 0.5% of total population in Korea, from 2012 to 2016. Furthermore, costs for treatments of diabetic foot ulcer are increasing, especially those for the limb saving group.
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Kurup R, Ansari AA. A study to identify bacteriological profile and other risk factors among diabetic and non-diabetic foot ulcer patients in a Guyanese hospital setting. Diabetes Metab Syndr 2019; 13:1871-1876. [PMID: 31235108 DOI: 10.1016/j.dsx.2019.04.024] [Citation(s) in RCA: 5] [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] [Received: 03/31/2019] [Accepted: 04/16/2019] [Indexed: 12/15/2022]
Abstract
Diabetic foot infection is a global epidemic and a major public health concern. Development of microbial resistance to many antimicrobial agents in foot ulcer leads to serious complications. Therefore, the study aims to identify the microbiological profile and the potential risk factors among diabetic and non-diabetic foot ulcer patients. A prospective cross sectional study was carried out among 183 ulcer patients from diabetic foot clinic and wound dressing clinic at the public health hospital, Guyana. A total of 254 bacteria were isolated from the study with an average of 1.4 organism per lesion. Gram negative bacteria (63.0%) were prevalent than gram positive bacteria (37.0%) in this study. Among DF patients, Pseudomonas aeruginosa (18.8%) was the most common isolate followed by Escherichia coli (13.9%) among gram negative group. Were as MRSA (12.1%) followed by MSSA (7.9%) dominated among gram positive group in diabetic foot patients. Almost 42.1% (95% CI 34.8-49.6) of the infections were caused by poly-microbial. Interestingly, a stepwise logistic regression model determined increasing age and lack of health education as independent risk factor identified for acquiring an MDR wound infection (OR = 1.1; p ≥ 0.05; 95% CI 1.0-1.1). Mild, moderate and severe infection among MDR and NMDR patients were recorded as 45.3% (95% CI 32.8-58.3), 26.5% (95% CI 16.3-39.1), 28.1% (95% CI 17.6-40.8) and 51.3% (95% CI 41.9-60.5), 32.8% (95% CI 24.4-42.0), 16.0% (95% CI 9.9-23.8). Therefore, it is concluded that there's an urgent need for surveillance of resistant bacteria in diabetic foot infections to reduce the risk of major complications.
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Affiliation(s)
- Rajini Kurup
- Faculty of Health Sciences, University of Guyana, Guyana.
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Regeneration of Diabetic Foot Ulcers Based on Therapy with Red LED Light and a Natural Latex Biomembrane. Ann Biomed Eng 2019; 47:1153-1164. [DOI: 10.1007/s10439-019-02220-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
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Cardoso HC, Zara ALDSA, Rosa SDSRF, Rocha GA, Rocha JVC, de Araújo MCE, Quinzani PDF, Barbosa YP, Mrué F. Risk Factors and Diagnosis of Diabetic Foot Ulceration in Users of the Brazilian Public Health System. J Diabetes Res 2019; 2019:5319892. [PMID: 31612148 PMCID: PMC6755287 DOI: 10.1155/2019/5319892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/03/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND An individual with diabetes mellitus (DM) has an approximately 25% risk of developing ulcerations and/or destruction of the feet's soft tissues. These wounds represent approximately 20% of all causes of hospitalizations due to DM. OBJECTIVE To identify the factors for the development of diabetic foot ulceration (DFU) among individuals treated by the Brazilian public health system. METHODS This cross-sectional study was conducted on individuals with diabetes mellitus, aged above 18 years, of both sexes, and during July-October 2018 within a public healthcare unit in Brazil. All participants were assessed based on their socioeconomic, behavioral, and clinical characteristics, along with vascular and neurological evaluations. All participants were also classified according to the classification of risk of developing DFU, in accordance with the International Working Group on the Diabetic Foot (IWGDF). Statistical analyses were conducted using the chi-squared test, chi-squared test for trend, and Fisher's exact test, with a significance level of 5% (p < 0.05). RESULTS The study consisted of 85 individuals. The DFU condition was prevalent in 10.6% of the participants. Adopting the classification proposed by IWGDF, observed risks for stratification categories 0, 1, 2, and 3 were 28.2%, 29.4%, 23.5%, and 8.2%, respectively. A statistically significant (p < 0.05) association was observed between the development of DFU and the following variables: time since the diagnosis of diabetes and the appearance of the nails, humidity, and deformations on the feet. CONCLUSION The present study found an elevated predominance of DM patients in the Brazilian public health system (SUS) featuring cutaneous alterations that may lead to ulcers; these individuals had elevated risks of developing DFU. Furthermore, it was revealed that the feet of patients were not physically examined during treatment.
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Affiliation(s)
- Hígor Chagas Cardoso
- Postgraduate Program of Health Sciences, Federal University of Góias, Goiânia, Goiás 75605-050, Brazil
| | | | | | - Gabriel Alves Rocha
- Undergraduate Program of Medicine, University Center of Anápolis Unievangélica, Anápolis, Goiás 75075-010, Brazil
| | - João Victor Costa Rocha
- Undergraduate Program of Medicine, University Center of Anápolis Unievangélica, Anápolis, Goiás 75075-010, Brazil
| | - Maria Clara Emos de Araújo
- Undergraduate Program of Medicine, University Center of Anápolis Unievangélica, Anápolis, Goiás 75075-010, Brazil
| | - Pedro de Freitas Quinzani
- Undergraduate Program of Medicine, University Center of Anápolis Unievangélica, Anápolis, Goiás 75075-010, Brazil
| | - Yaman Paula Barbosa
- Undergraduate Program of Medicine, University Center of Anápolis Unievangélica, Anápolis, Goiás 75075-010, Brazil
| | - Fátima Mrué
- Postgraduate Program of Health Sciences, Federal University of Góias, Goiânia, Goiás 75605-050, Brazil
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