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Drovandi A, Seng L, Golledge J. Effectiveness of educational interventions for diabetes-related foot disease: A systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40:e3746. [PMID: 37926437 DOI: 10.1002/dmrr.3746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
This systematic review and meta-analysis pooled evidence from randomised controlled trials (RCTs) on the effectiveness of educational programs for people with or at risk of diabetes-related foot disease (DFD). A systematic search identified RCTs evaluating the effectiveness of educational programs in preventing or managing DFD. The primary outcome was risk of developing a foot ulcer. Secondary outcomes included any amputation, mortality, changes in cardiovascular risk factors, foot-care knowledge and self-care behaviours. Meta-analyses were performed using random effects models. Risk of bias was assessed using Cochrane's ROB-2 tool. Education programs were tested in 29 RCTs (n = 3891) and reduced risk of a foot ulcer by approximately half although the upper 95% confidence interval (CI) reached 1.00 (odds ratio [OR], OR 0.54; 95% CI 0.29, 1.00, I2 = 65%). Education programs reduced risk of any amputation (OR 0.34; 95% CI 0.13, 0.88, I2 = 38%) and HbA1c levels (standardized mean difference -0.73; 95% CI -1.26, -0.20, I2 = 93%) without affecting all-cause mortality (OR 1.09; 95% CI 0.57, 2.07, I2 = 0%). Education programs mostly significantly improved DFD knowledge (13 of 16 trials) and self-care behaviour scores (19 of 20 trials). Only one trial was deemed at low risk of bias. Previously tested education programs have mostly effectively improved participants' knowledge and self-care behaviours and reduced risk of foot ulceration and amputation. Larger high quality trials with longer follow-up are needed.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Alahakoon C, Thanigaimani S, Seng L, Fernando M, Lazzarini P, Golledge J. Editor's Choice - A Systematic Review and Meta-Analysis of the Incidence and Risk Factors for Re-admission to Hospital in People with Diabetes Related Foot Disease. Eur J Vasc Endovasc Surg 2023; 66:195-202. [PMID: 37182607 DOI: 10.1016/j.ejvs.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The aim of this study was to systematically review the incidence and risk factors for 30 day re-admission to hospital following an index admission to treat diabetes related foot disease (DFD). DATA SOURCES A literature search was conducted using Medline/PubMed, Scopus, Cochrane Library, and CINAHL databases. METHODS The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies that reported the rate of total or DFD related 30 day re-admissions were included. Meta-analysis was performed using a random effects model to calculate the pooled mean (95% confidence interval [CI]) of the proportion of patients re-admitted to hospital within 30 days. Meta-regression was performed to determine the association between risk factors and 30 day re-admission. RESULTS Sixteen retrospective studies with a total of 124 683 participants were included. The mean total 30 day re-admission rate was 22.0% (95% CI 17.0 - 27.0%) while the mean DFD related 30 day re-admission rate was 10.0% (95% CI 7.0 - 15.0%). Meta-regression found that greater prevalence of peripheral neuropathy (p = .045) was associated with a higher rate of any 30 day re-admission, and male sex (p = .023) and private health insurance (p = .048) were associated with lower rates of any 30 day re-admission. Coronary artery disease (p= .025) was associated with a higher rate of DFD related re-admission. All studies had low or moderate risk of bias. CONCLUSION This systematic review suggested that about one fifth of patients with DFD are re-admitted to hospital within 30 days, of which about half are to treat DFD. Risk factors for re-admission included female gender, peripheral neuropathy, lack of private health insurance, and coronary artery disease.
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Affiliation(s)
- Chanika Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Shivshankar Thanigaimani
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Malindu Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, New South Wales, Australia
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
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Drovandi A, Crowley B, Alahakoon C, Seng L, Fernando ME, Ross D, Evans R, Golledge J. Perceptions of Australians with diabetes-related foot disease on requirements for effective secondary prevention. Aust J Rural Health 2023; 31:690-703. [PMID: 37092611 PMCID: PMC10947538 DOI: 10.1111/ajr.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Secondary prevention is essential in reducing recurrence of diabetes-related foot disease (DFD) but is frequently poorly implemented in clinical practice. OBJECTIVE To explore the perceptions of people with diabetes-related foot disease (DFD) on their self-perceived knowledge in managing DFD, facilitators and barriers influencing their DFD care, and ideas and preferences for a secondary prevention program. DESIGN Sixteen people with a history of DFD from Queensland and Victoria, Australia, underwent semi-structured interviews. Interviews were audio-recorded over telephone and transcribed and analysed following a thematic framework. Participants were asked about their experiences and perceptions relating to DFD and factors influencing the care they receive for DFD relevant to the development of a secondary prevention program for DFD. FINDINGS AND DISCUSSION Participants had high self-perceived knowledge in managing DFD, especially in implementing healthy lifestyle changes and conducting daily foot checks and foot care, though most received support from family members acting as carers. However, issues with access and adherence to offloading footwear, and a lack of clear education received on footwear and other aspects of DFD care were perceived as major barriers. Improved patient education, provided in a consistent manner by proactive clinicians was perceived as an essential part of secondary prevention. Telehealth was perceived positively through facilitating faster care and considered a good adjunct to standard care. Health and technological literacy were considered potentially major barriers to the effectiveness of remote care. CONCLUSION People with DFD require improved access to offloading footwear and education about secondary prevention, which could be provided by telehealth with adequate support.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Faculty of Biological Sciences, School of Biomedical SciencesUniversity of LeedsLeedsUK
| | - Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Chanika Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Malindu E. Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
- Faculty of Health and Medicine, School of Health SciencesUniversity of NewcastleNewcastleNew South WalesAustralia
- Department of Vascular and Endovascular Surgery, John Hunter HospitalHunter New England Local Health District, New South Wales HealthNewcastleNew South WalesAustralia
| | - Diane Ross
- Townsville Aboriginal and Islander Health ServicesTownsvilleQueenslandAustralia
| | - Rebecca Evans
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
- Department of Vascular and Endovascular SurgeryTownsville University HospitalTownsvilleQueenslandAustralia
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Crowley B, Drovandi A, Seng L, Fernando ME, Ross D, Golledge J. Patient Perspectives on the Burden and Prevention of Diabetes-Related Foot Disease. Sci Diabetes Self Manag Care 2023; 49:217-228. [PMID: 37114642 DOI: 10.1177/26350106231170531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE The purpose of the study was to understand patient perspectives about the impact and prevention of diabetes-related foot disease (DFD). METHODS An online survey was distributed to patients with a history of DFD during 2020. The survey was designed alongside clinical specialists and DFD patients and utilized the health belief model. It asked about the impact of DFD on health, perceptions on preventive strategies, perceived need for additional support, and patient preferences for telehealth in DFD management. Quantitative data were summarized descriptively and compared between groups. Open-text responses were analyzed using conceptual content analysis. RESULTS Of 80 participants with a history of DFD, foot ulcers were the complication most often experienced, with over two-thirds having been admitted to hospital for a DFD-related issue and over one-third having a DFD-related amputation. Participants had ranging perceptions on the effect of DFD on health, from minimal to crippling. Those with previous severe DFD complications leading to hospital admission found a lack of mobility and independence the consequences of most concern. Using offloading footwear was perceived as very important for preventing DFD complications, although the use of offloading footwear was low, with participants citing issues relating to cost, comfort, appearance, and access to footwear as barriers to better adherence. Perceptions on telehealth were mixed, with many participants not having access to or being comfortable with the use of digital technologies. CONCLUSIONS Patients with DFD require additional supports for effective prevention, including offloading footwear.
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Affiliation(s)
- Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, England
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Malindu E Fernando
- Ulcer and Wound Healing Consortium, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Diane Ross
- Townsville Aboriginal and Islander Health Services, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Ulcer and Wound Healing Consortium, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Drovandi A, Wong S, Seng L, Crowley B, Alahakoon C, Banwait J, Fernando ME, Golledge J. Remotely Delivered Monitoring and Management of Diabetes-Related Foot Disease: An Overview of Systematic Reviews. J Diabetes Sci Technol 2023; 17:59-69. [PMID: 34008448 PMCID: PMC9846412 DOI: 10.1177/19322968211012456] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetes-related foot disease (DFD) management requires input from multiple healthcare professionals, and has worse outcomes for people living in remote localities by comparison to urban areas. Remotely delivered healthcare may reduce this disparity. This overview summarizes current evidence on the effectiveness, stakeholder perceptions, and cost-effectiveness of remotely delivered healthcare for DFD. METHODS A search of 5 databases was conducted to identify systematic reviews published between January 2000 and June 2020. Eligible reviews were those evaluating remotely delivered monitoring or management of patients at risk of or with active DFD, or clinicians managing these patients. Risk of bias was assessed using the AMSTAR-2 tool. RESULTS Eight reviews were eligible for inclusion, including 88 primary studies and 8509 participants, of which 36 studies involving 4357 participants evaluated remotely delivered monitoring or management of DFD. Only one review had a low risk of bias, with most reviews demonstrating limited search strategies and poor reporting of participants. Evidence on effectiveness was mixed, with meta-analyses demonstrating long-term ulcer healing and mortality were not significantly different between telehealth and standard care groups, although the lower-limb amputation rate was significantly decreased in one meta-analysis. Perceptions of telehealth by patients and clinicians were generally positive, whilst acknowledging limitations relating to access and use. Cost-effectiveness data were limited, with poor reporting preventing clear conclusions. CONCLUSIONS Remotely delivered healthcare of DFD is well received by patients and clinicians, but its effectiveness is unclear. High quality trials are needed to evaluate the risks and benefits of remotely delivered DFD management.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
| | - Shannon Wong
- College of Medicine and Dentistry,
James Cook University, Townsville, Queensland, Australia
| | - Leonard Seng
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
| | - Benjamin Crowley
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
| | - Chanika Alahakoon
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
| | - Jasmin Banwait
- College of Medicine and Dentistry,
James Cook University, Townsville, Queensland, Australia
| | - Malindu E. Fernando
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
- Ulcer and wound Healing consortium
(UHEAL), Australian Institute of Tropical Health and Medicine, James Cook
University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
- Ulcer and wound Healing consortium
(UHEAL), Australian Institute of Tropical Health and Medicine, James Cook
University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular
Surgery, Townsville University Hospital, Townsville, Queensland, Australia
- Jonathan Golledge, MChir, Queensland
Research Centre for Peripheral Vascular Disease, College of Medicine and
Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland
4811, Australia.
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Drovandi A, Seng L, Crowley B, Fernando ME, Evans R, Golledge J. Health Professionals' Opinions About Secondary Prevention of Diabetes-Related Foot Disease. Sci Diabetes Self Manag Care 2022; 48:349-361. [PMID: 35837980 DOI: 10.1177/26350106221112115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to explore the perceptions of health professionals regarding the ideal design of a remotely delivered diabetes-related foot disease (DFD) secondary prevention program. METHODS A qualitative study involving 33 semistructured phone interviews was conducted with health professionals with experience managing DFD. Interviews discussed the role of health professionals in managing DFD, their experience in using telehealth, perceived management priorities, preferences for a secondary prevention management program, and perceived barriers and facilitators for such a program. Interviews were audio-recorded and transcribed, and inductive thematic analysis was used to derive key themes. RESULTS Three themes were derived: (1) barriers in current model of DFD care, (2) facilitators and ideas for a remotely delivered secondary prevention program, and (3) potential challenges in implementation. DFD care remains acute-care focused, with variability in access to care and a lack of "clinical ownership." Patients were perceived as often having poor knowledge and competing priorities, meaning engagement in self-care remains poor. Participants felt a remote secondary prevention program should be simple to follow and individualized to patients' context, with embedded support from a case manager and local multidisciplinary service providers. Challenges to implementation included limited DFD awareness, poor patient motivation, patient-related issues with accessing and using technology, and the inability to accurately assess and treat the foot over telehealth. CONCLUSIONS Health professionals felt that an ideal remotely delivered secondary prevention program should be tailored to patients' needs with embedded support from a case manager and complemented with multidisciplinary collaboration with local service providers.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | | | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.,Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia
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Drovandi A, Seng L, Crowley B, Fernando ME, Golledge J. Health Professionals' Opinions About Secondary Prevention of Diabetes-Related Foot Disease. INT J LOW EXTR WOUND 2022:15347346221099798. [PMID: 35578540 DOI: 10.1177/15347346221099798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study explored health professionals' perceptions of current issues and opportunities for the secondary prevention of diabetes-related foot disease (DFD), and potential strategies for improving DFD care. From May to October 2020, relevant Australian health professionals completed an online survey which used ordinal scales, ranking questions, and open text fields to assess perceptions about the importance of aspects of secondary prevention for DFD and elements for a prevention program. Quantitative data were summarised and compared between professions using non-parametric tests, and qualitative data was analysed using conceptual content analysis to identify emerging themes. Perceptions from 116 health professionals with experience in managing patients with DFD were obtained, including 69 podiatrists, 21 vascular surgeons, 16 general practitioners, and ten nurses. Access and adherence to appropriate offloading footwear was perceived as a key element for effective DFD care, and believed to be affected by social and economic factors, such as the cost of footwear, as well as patient-related factors, such as motivation to wear footwear and adhere to other medical therapies. In addition to a lack of patient motivation and financial limitations, health professionals also believed patients lacked an understanding of the likelihood and severity of DFD recurrence. Several elements of care were perceived as missing from practice, including psychological support and ways to improve footwear adherence, with health professionals identifying several strategies for the design and implementation of an effective secondary prevention program. Prospective trials evaluating secondary prevention programs are required to determine the most effective means for preventing DFD recurrence.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
| | - Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, 104560James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Seng L, Drovandi A, Fernando ME, Golledge J. Opinions about the most appropriate surgical management of diabetes-related foot infection: a cross-sectional survey. J Foot Ankle Res 2022; 15:18. [PMID: 35232476 PMCID: PMC8889647 DOI: 10.1186/s13047-022-00523-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is a lack of high quality evidence to guide the optimal management of diabetes-related foot infection, particularly in cases of severe diabetes-related foot infection and diabetes-related foot osteomyelitis. This study examined the opinions of surgeons about the preferred management of severe diabetes-related foot infection. Methods Vascular and orthopaedic surgeons in Australia and New Zealand were invited to complete an online survey via email. The survey included multi-choice and open-ended questions on clinical management of diabetes-related foot infection. Responses of vascular surgeons and orthopaedic surgeons were compared using non-parametric statistical tests. Open-text responses were examined using inductive content analysis. Results 29 vascular and 20 orthopaedic surgeons completed the survey. One-third (28.6%) used best-practice guidelines to assist in decisions about foot infection management. Areas for guideline improvement identified included more specific advice regarding the indications for available treatments, more recommendations about non-surgical patient management and advice on how management can be varied in regions with limited health service resource. The probe-to-bone test and magnetic resonance imaging were the preferred methods of diagnosing osteomyelitis. Approximately half (51.2%) of respondents indicated piperacillin combined with tazobactam as the preferred antibiotic choice for empirical treatment of severe diabetes-related foot infection. Negative pressure wound therapy was the most common way of managing a wound following debridement. All vascular surgeons (100%) made revascularisation decisions based on the severity of ischemia while most orthopaedic surgeons (66.7%) were likely to refer to vascular surgeons to make revascularisation decisions. Vascular surgeons preferred using wound swabs while orthopaedic surgeons favoured tissue or bone biopsies to determine the choice of antibiotic. Respondents perceived a moderate variation in management decisions between specialists and supported the need for randomised controlled trials to test different management pathways. Conclusions Most vascular and orthopaedic surgeons do not use best-practice guidelines to assist in decisions about management of diabetes-related foot infection. Vascular and orthopaedic surgeons appear to have different preferences for wound sampling to determine choice of antibiotic. There is a need for higher quality evidence to clarify best practice for managing diabetes-related foot infection. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00523-w.
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Affiliation(s)
- Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia.,Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.,Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia. .,Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia. .,Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
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Fernando ME, Seng L, Drovandi A, Crowley BJ, Golledge J. Corrigendum: Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne) 2022; 13:916377. [PMID: 35615715 PMCID: PMC9125425 DOI: 10.3389/fendo.2022.916377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fendo.2022.848695.].
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Affiliation(s)
- Malindu E. Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Ulcer and Wound Healing Consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Ulcer and Wound Healing Consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Benjamin J. Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Ulcer and Wound Healing Consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia
- *Correspondence: Jonathan Golledge,
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Fernando ME, Seng L, Drovandi A, Crowley BJ, Golledge J. Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne) 2022; 13:848695. [PMID: 35370974 PMCID: PMC8965099 DOI: 10.3389/fendo.2022.848695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes. PURPOSE To pool evidence from randomized controlled trials testing remote management interventions to simultaneously control blood pressure, blood glucose and lipids. DATA SOURCES PubMed/Medline, EMBASE, CINAHL and the Cochrane library were systematically searched for randomized controlled trials (RCTs) until 20th June 2021. STUDY SELECTION Included RCTs were those that reported participant data on blood pressure, blood glucose, and lipid outcomes in response to a remotely delivered intervention. DATA EXTRACTION Three authors extracted data using a predefined template. Primary outcomes were glycated hemoglobin (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), systolic and diastolic blood pressure (SBP & DBP). Risk of bias was assessed using the Cochrane collaboration RoB-2 tool. Meta-analyses are reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI). DATA SYNTHESIS Twenty-seven RCTs reporting on 9100 participants (4581 intervention and 4519 usual care) were included. Components of the remote management interventions tested were identified as patient education, risk factor monitoring, coaching on monitoring, consultations, and pharmacological management. Comparator groups were typically face-to-face usual patient care. Remote management significantly reduced HbA1c (SMD -0.25, 95%CI -0.33 to -0.17, p<0.001), TC (SMD -0.17, 95%CI -0.29 to -0.04, p<0.0001), LDL-c (SMD -0.11, 95%CI -0.19 to -0.03, p=0.006), SBP (SMD -0.11, 95%CI -0.18 to -0.04, p=0.001) and DBP (SMD -0.09, 95%CI -0.16 to -0.02, p=0.02), with low to moderate heterogeneity (I²= 0 to 75). Twelve trials had high risk of bias, 12 had some risk and three were at low risk of bias. LIMITATIONS Heterogeneity and potential publication bias may limit applicability of findings. CONCLUSIONS Remote management significantly improves control of modifiable risk factors. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258433], identifier PROSPERO (CRD42021258433).
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Affiliation(s)
- Malindu E. Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Ulcer and Wound Healing Consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Ulcer and Wound Healing Consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Benjamin J. Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Ulcer and Wound Healing Consortium (UHEAL), Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia
- *Correspondence: Jonathan Golledge,
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van Netten JJ, Seng L, Lazzarini PA, Warnock J, Ploderer B. Reasons for (non-)adherence to self-care in people with a diabetic foot ulcer. Wound Repair Regen 2019; 27:530-539. [PMID: 31107578 DOI: 10.1111/wrr.12728] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/14/2019] [Indexed: 12/20/2022]
Abstract
We aimed to explore reasons for (non-)adherence to self-care among people with diabetic foot ulcers, as well as barriers and solutions to improving their self-care adherence. We performed a qualitative study, recruiting people with a diabetic foot ulcer from a community diabetic foot clinic. Semistructured interviews were held with participants. Data saturation occurred after 9 and was confirmed after 11 participant interviews. Interviews were audio-taped, transcribed verbatim and analyzed using the framework approach. Findings were mapped and the World Health Organization's (WHO) adherence dimensions were applied to themes identified. The key themes identified were (1) participants performed recommended practices in self-care; (2) participants relied heavily on care support; (3) motivations for self-care came from "staying well"; and (4) there was a disparity between self-care knowledge and understanding. Barriers identified included poor mobility and visibility, difficulty wearing offloading devices or using wound dressings, and frustration with lack of progress. Solutions to improve adherence included integrating self-care as routine, improved education, more external help and improving visibility. All five WHO adherence dimensions played a role in (non-)adherence to diabetic foot ulcer self-care. We conclude that adherence to recommended diabetic foot ulcer self-care was limited at best, and reasons for nonadherence were multidimensional. Based on the factors related to (non-)adherence and the barriers and solutions described, we suggest clinicians obtain a broad view of a person's situation when aiming to improve self-care adherence.
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Affiliation(s)
- Jaap J van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Department of surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Leonard Seng
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Allied Health Research Collaborative, Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Australia
| | - Jason Warnock
- Podiatry Service, Metro North Hospital and Health Service, The Prince Charles Hospital, Brisbane, Australia
| | - Bernd Ploderer
- School of Electrical Engineering and Computer Science, Queensland University of Technology, Brisbane, Australia
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Othman M, Majid M, Singh M, Subathra S, Seng L, Gam LH. Proteomics of Grade 3 infiltrating ductal carcinoma in Malaysian Chinese breast cancer patients. Biotechnol Appl Biochem 2010. [DOI: 10.1111/j.1470-8744.2009.tb00896.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Kettaneh A, Seng L, Tiev KP, Tolédano C, Fabre B, Cabane J. Human leukocyte antigens and susceptibility to tuberculosis: a meta-analysis of case-control studies. Int J Tuberc Lung Dis 2006; 10:717-25. [PMID: 16848331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE To evaluate the association between human leukocyte antigens (HLA) of the major histocompatibility complex (MHC) and thoracic tuberculosis (TB) in immunocompetent adults. DESIGN We searched Medline, Pascal, Pascal Biomed and Francis databases (all years) with the terms 'tuberculosis' and 'HLA'. Case-control studies were included that reported frequencies for the full range of antigens analysed by serological methods in healthy controls and adult patients not treated with glucocorticoids or immunosuppressive drugs, human immunodeficiency virus status negative or not reported, no debilitating chronic disease, and with a diagnosis of thoracic TB based on microbiological or histological criteria. Two authors independently abstracted the data and resolved disagreements by consensus. RESULTS We summarised 60 HLA antigens reported in at least four of 22 studies totalling 1988 patients and 2897 controls. A lower risk of thoracic TB was found in carriers of B13 (OR 0.64, 95% CI 0.50-0.81, P < 0.0001), DR3 (OR 0.72, 95% CI 0.59-0.89, P = 0.002), and DR7 antigens (OR 0.65, 95% CI 0.53-0.80, P < 0.0001). Carriers of DR8 were at higher risk for thoracic TB (OR 1.72, 95% CI 1.21-2.46, P = 0.003). For these antigens, we found no significant heterogeneity between samples or evidence of publication bias. The risk of thoracic TB tended to be higher in carriers of DR2 (OR 1.67, 95% CI 1.16-2.41, P = 0.006), but the results were not consistent between studies (P value for heterogeneity < 0.0001). CONCLUSION Susceptibility to TB is modulated by class I and II HLA antigens. However, these results based on the serological determination of antigens require confirmation by DNA-based methods to precisely identify those alleles involved.
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Affiliation(s)
- A Kettaneh
- Department of Internal Medicine, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Plaut SM, Maxwell SA, Seng L, O'Brien JJ, Fairclough GF. Mental health services for medical students: perceptions of students, student affairs deans, and mental health providers. Acad Med 1993; 68:360-365. [PMID: 8484849 DOI: 10.1097/00001888-199305000-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
PURPOSE To examine (1) whether there is any consistency among medical schools in mental health services provided and (2) how these services are perceived by student affairs deans, mental health service providers, and the students themselves. METHOD Questionnaires were sent in October 1991 to the student affairs dean (or director), the individual responsible for student mental health services, and a student representative in each of the 126 U.S. and Canadian medical schools. Data were sought regarding personnel, individuals served, location, hours, administration, funding, confidentiality, administrative referrals, and respondents' suggestions for improvement. Possible differences among the three groups of respondents were tested by chi-square. RESULTS Responses were received from 75 student affairs deans, 53 mental health providers, and 30 students. There was much diversity among schools in services provided, especially in the areas of administration and funding. Although perceptions of the three respondent groups were often the same, they differed significantly in a number of areas. Suggestions for improvement of services involved funding, personnel, hours, confidentiality and privacy, specialty services, preventive and support programs, and visibility. The suggestion most frequently made by the students was for increased information and visibility. CONCLUSION The differences among schools coupled with the differing perceptions within schools indicate a need for a comprehensive consideration of what kinds of mental health services are needed and how they can best be made accessible to a diverse body of students experiencing a variety of academic and personal challenges.
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Affiliation(s)
- S M Plaut
- Office of Student Affairs, University of Maryland School of Medicine, Baltimore 21201
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Thepsuparungsikul V, Seng L, Bailey GB. Differentiation of Entamoeba: encystation of E. invadens in monoxenic and axenic cultures. J Parasitol 1971; 57:1288-92. [PMID: 4945444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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