1
|
Mairghani M, Patton D, Sorensen J, Elmusharaf K, Jassim G, Eltahir O, Moore Z. Health-related quality of life in patients with diabetic foot ulcers in the Arab world: a systematic review. J Wound Care 2024; 33:253-261. [PMID: 38573904 DOI: 10.12968/jowc.2024.33.4.253] [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: 04/06/2024]
Abstract
OBJECTIVE To conduct a systematic review to identify the impact of diabetic foot ulceration (DFU) on health-related quality of life (HRQoL) in individuals within the Arab world. METHOD A PRISMA-guided systematic search for HRQoL studies in Arab populations was conducted in CINAHL, PubMed, Scopus and EBSCO. Relevant studies were critically appraised using the STROBE statement checklist. RESULTS A total of five studies were included. Three studies originated from Saudi Arabia, one from Jordan and one from Tunisia. The studies consistently demonstrated lower (poorer) HRQoL in patients with DFU, and worse HRQoL compared with both patients with diabetes and no DFU, and with healthy subjects. CONCLUSION This review confirmed the negative impact of DFU on HRQoL in individuals with diabetes. It also highlights the scarcity of HRQoL studies from the Arab world. However, given that all studies included were conducted between 2013-2019, this could reflect a growing interest in DFU and HRQoL in the Arab world, and could potentially indicate that more studies will follow. In light of this, there is a need for a renewed focus on the completion of a high-quality standardised approach to research in this region.
Collapse
Affiliation(s)
- Maisoon Mairghani
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Converge: Centre for Chronic Disease and Population Health Research, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Declan Patton
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Omer Eltahir
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zena Moore
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
2
|
Zamzam A, McLaren A, Ram E, Syed MH, Rave S, Lu SH, Al‐Omran M, de Mestral C. A novel Canadian multidisciplinary acute care pathway for people hospitalised with a diabetic foot ulcer. Int Wound J 2023; 20:3331-3337. [PMID: 37150835 PMCID: PMC10502294 DOI: 10.1111/iwj.14214] [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: 02/20/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023] Open
Abstract
This manuscript describes the implementation and initial evaluation of a novel Canadian acute care pathway for people with a diabetic foot ulcer (DFU). A multidisciplinary team developed and implemented an acute care pathway for patients with a DFU who presented to the emergency department (ED) and required hospitalisation at a tertiary care hospital in Canada. Processes of care, length of stay (LOS), and hospitalisation costs were considered through retrospective cohort study of all DFU hospitalizations from pathway launch in December 2018 to December 2020. There were 82 DFU-related hospital admissions through the ED of which 55 required invasive intervention: 28 (34.1%) minor amputations, 16 (19.5%) abscess drainage and debridement, 6 (7.3%) lower extremity revascularisations, 5 (6.1%) major amputations. Mean hospital LOS was 8.8 ± 4.9 days. Mean hospitalisation cost was $20 569 (±14 143): $25 901 (±15 965) when surgical intervention was required and $9279 (±7106) when it was not. LOS and hospitalisation costs compared favourably to historical data. An acute care DFU pathway can support the efficient evaluation and management of patients hospitalised with a DFU. A dedicated multidisciplinary DFU care team is a valuable resource for hospitals in Canada.
Collapse
Affiliation(s)
- Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
| | - Ann‐Marie McLaren
- Chiropody TeamUnity Health Toronto—St. Michael's HospitalTorontoOntarioCanada
| | - Emily Ram
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
| | - Muzammil H. Syed
- Division of Vascular Surgery, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
| | - Sreenath Rave
- Chiropody TeamUnity Health Toronto—St. Michael's HospitalTorontoOntarioCanada
| | - Suzanne H. Lu
- Chiropody TeamUnity Health Toronto—St. Michael's HospitalTorontoOntarioCanada
| | - Mohammed Al‐Omran
- Division of Vascular Surgery, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhKingdom of Saudi Arabia
- Diabetes Action CanadaTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Charles de Mestral
- Division of Vascular Surgery, St. Michael's HospitalUnity Health TorontoTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- Department of SurgeryKing Faisal Specialist Hospital and Research CenterRiyadhKingdom of Saudi Arabia
- Diabetes Action CanadaTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
3
|
Graves N, Ganesan G, Tan KB, Goh OQ, Ho J, Chong TT, Bishnoi P, Carmody D, Yuh AS, Ng YZ, Lo Z, Enming Y, Abu Bakar Aloweni F, Zifei W, Harding K. Chronic wounds in a multiethnic Asian population: a cost of illness study. BMJ Open 2023; 13:e065692. [PMID: 37723106 PMCID: PMC10510887 DOI: 10.1136/bmjopen-2022-065692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE To estimate the 'cost of illness' arising from chronic wounds in Singapore. DESIGN Incidence-based cost of illness study using evidence from a range of sources. SETTING Singapore health services. PARTICIPANTS We consider 3.49 million Singapore citizens and permanent residents. There are 16 752 new individuals with a chronic wound in 2017, with 598 venous ulcers, 2206 arterial insufficiency ulcers, 6680 diabetic ulcers and 7268 pressure injuries.Primary outcome measures expressed in monetary terms are the value of all hospital bed days lost for the population; monetary value of quality-adjusted life years (QALYs) lost in the population; costs of all outpatient visits; and costs of all poly clinic, use of Community Health Assist Scheme (CHAS) and emergency departments (EDs) visits. Intermediate outcomes that inform the primary outcomes are also estimated. RESULTS Total annual cost of illness was $350 million (range $72-$1779 million). With 168 503 acute bed days taken up annually (range 141 966-196 032) that incurred costs of $139 million (range 117-161 million). Total costs to health services were $184 million (range $120-$1179 million). Total annual costs of lost health outcomes were 2077 QALYs (range -2657 to 29 029) valued at $166 million (range -212 to 2399 million). CONCLUSIONS The costs of chronic wounds are large to Singapore. Costs can be reduced by making positive investments for comprehensive wound prevention and treatment programmes.
Collapse
Affiliation(s)
- Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ganga Ganesan
- Health Services Research, Ministry of Health, Singapore
| | - Kelvin Bryan Tan
- SingHealth Duke-NUSGlobal Health Institute, Duke-NUS Medical School, Singapore
| | - Orlanda Qm Goh
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Jackie Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Priya Bishnoi
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - David Carmody
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Ang Shin Yuh
- Nursing Division, Singapore General Hospital, Singapore
| | - Yi Zhen Ng
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Zhiwen Lo
- Department of Surgery, Vascular Surgery Woodlands Health, Singapore
| | - Yong Enming
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Wang Zifei
- Skin Research Institute of Singapore (SRIS), Singapore
| | - Keith Harding
- Skin Research Institute of Singapore (SRIS), Singapore
| |
Collapse
|
4
|
Abu El Hawa AA, Dekker PK, Mishu MD, Kim KG, Mizher R, Fan KL, Attinger CE, Evans KK. Early Diagnosis and Surgical Management of Necrotizing Fasciitis of the Lower Extremities: Risk Factors for Mortality and Amputation. Adv Wound Care (New Rochelle) 2022; 11:217-225. [PMID: 34297612 DOI: 10.1089/wound.2021.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: In this study, we seek to identify patient characteristics associated with limb loss and mortality while exploring the potential impact a multidisciplinary care team may have. Approach: This was a 10-year retrospective review of patients presenting to our tertiary care center for limb salvage with a diagnosis of lower extremity (LE) necrotizing fasciitis (NF). Patient demographics, clinical history, and outcomes were compared between survivors and nonsurvivors and between those who underwent LE amputation and those who did not. The article adheres to the strengthening the reporting of observational studies in epidemiology statement. Results: Sixty-two patients presented to our tertiary care center for limb salvage with LE NF. Forty-two patients underwent LE amputation: 27 (43.5%) underwent below-knee amputation, 1 (1.6%) underwent above-knee amputation, 8 (12.9%) underwent transmetatarsal amputation and 2 (3.2%) underwent calcanectomy. The overall mortality rate was 16.1% (n = 10). Risk factors for mortality included increased age (p = 0.034), higher Charlson Comorbidity Index (p = 0.011), thrombocytopenia (p = 0.002), hypotension (p = 0.015), erythema (p = 0.010), pain (p = 0.027), diabetes mellitus (p = 0.012), and malignancy (p < 0.001). Risk factors for LE amputation included DM (p = 0.017), peripheral vascular disease (p = 0.033), and an elevated laboratory risk indicator for necrotizing fasciitis (LRINC) (p = 0.033). Innovation: To identify outcomes after admission to a tertiary hospital with a dedicated limb salvage team with LE NF and to analyze risk factors for mortality and amputation. Conclusions: This is a comprehensive analysis of risk factors for mortality and amputation after LE NF. Our institution's experience highlights the importance of a multidisciplinary approach in the care of these patients.
Collapse
Affiliation(s)
| | - Paige K. Dekker
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Mark D. Mishu
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Kevin G. Kim
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Rami Mizher
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Kenneth L. Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Christopher E. Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Karen K. Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| |
Collapse
|
5
|
Graves N, Phillips CJ, Harding K. A narrative review of the epidemiology and economics of chronic wounds. Br J Dermatol 2021; 187:141-148. [PMID: 34549421 DOI: 10.1111/bjd.20692] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 12/11/2022]
Abstract
Chronic wounds have a debilitating effect on the quality of life of many individuals, and the large economic impact on health system budgets warrants greater attention in policy making and condition management than is currently evident. The aim of this narrative review is to summarize the nature and extent of the chronic wound problem that confronts health systems across the world. The first section is used to highlight the underlying epidemiology relating to chronic wounds, while the second explores the economic costs associated with them and the relative efficiency of measures designed to manage them.
Collapse
Affiliation(s)
- N Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - C J Phillips
- Department of Public Health and Policy Studies, Swansea University, Swansea, UK
| | - K Harding
- Clinical Innovation Hub, Cardiff University, Cardiff, UK
| |
Collapse
|
6
|
Tzeravini E, Tentolouris A, Tentolouris N, Jude EB. Advancements in improving health-related quality of life in patients living with diabetic foot ulcers. Expert Rev Endocrinol Metab 2018; 13:307-316. [PMID: 30381974 DOI: 10.1080/17446651.2018.1541403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Diabetic foot ulcer (DFU) constitutes a burden to patients with diabetes deteriorating their quality of life. Health related quality of life (HRQoL) can now be quantified with the use of specific tools; some of them provide a holistic approach to patients' well-being, while others are disease specific or even region specific. Many of these tools are applicable to patients with DFU. This review will present current data about the impact different interventions in the management of DFU on quality of life related parameters. AREAS COVERED We performed a search of literature using keywords 'diabetes mellitus', 'diabetic foot ulcer', 'diabetic foot', 'health related quality of life', 'quality of life' and 'SF-36' to identify studies that contained data about the relationship between different interventions and quality of life of patients with diabetic foot ulcers. EXPERT COMMENTARY Available data are not sufficient to conclude on the impact of interventions aimed to heal DFU on HRQoL. There is need for more, better designed studies and meta-analysis to estimate the effect of treatments on HRQoL in patients with DFUs. The development of new, diabetic foot specific tools will help to improve our knowledge in this field.
Collapse
Affiliation(s)
- Evangelia Tzeravini
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Anastasios Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Nikolaos Tentolouris
- a Diabetes Center, 1st Department of Propaedeutic Internal Medicine, Medical School , National and Kapodistrian University of Athens, Laiko General Hospital , Athens , Greece
| | - Edward B Jude
- b Department of Medicine, Diabetes Centre , Tameside Hospital NHS Foundation Trust , Ashton-under-Lyne , UK
- c Department of Medicine , Manchester University , Manchester , UK
- d Manchester Metropolitan University , Manchester , UK
| |
Collapse
|
7
|
Cheng Q, Graves N, Pacella RE. Economic Evaluations of Guideline-Based Care for Chronic Wounds: a Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:633-651. [PMID: 29968020 DOI: 10.1007/s40258-018-0403-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aim of this study was to review all published economic evaluations of guideline-based care for chronic wounds and to assess how useful these studies are for decision making in health services. METHODS Embase, PubMed, Scopus, Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database (NHS EED) were searched on April 16th, 2018. We included studies that evaluated the economic impact and health outcomes associated with implementing evidence-based guidelines as a bundle of care for the prevention and/or treatment of chronic wounds. Information was extracted from each eligible study and organized by the type of chronic wound. The quality of published economic evaluation studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). RESULTS A total of 24 economic evaluation studies met the inclusion criteria, of which 12 applied decision analytic models. The compliance with the CHEERS checklist ranged between 43 and 83%. LIMITATIONS We may have missed some economic evaluation studies despite the use of broad search terms. The quality assessment was conducted based on judgment. Using the CHEERS checklist may reflect the way evaluations were reported rather than conducted. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS We found that guideline-based care may be cost-saving or cost-effective in most circumstances. The quality and usefulness of reviewed studies for decision making were variable. Better information and higher-quality economic evaluations will increase decision makers' confidence to promote guideline-based care. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42017051859.
Collapse
Affiliation(s)
- Qinglu Cheng
- Australian Centre for Health Services Innovation (AusHSI), Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Nicholas Graves
- Australian Centre for Health Services Innovation (AusHSI), Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rosana E Pacella
- Australian Centre for Health Services Innovation (AusHSI), Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD, Australia
| |
Collapse
|
8
|
Buggy A, Moore Z. The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers: a systematic review. J Wound Care 2017; 26:324-339. [DOI: 10.12968/jowc.2017.26.6.324] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A. Buggy
- Professional Certificate (Community Nursing), RGN, CNM 2 Integrated Case Manager for Older Persons, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Z. Moore
- Dip First Line Management, RGN, Professor and Head of the School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
9
|
Petrakis I, Kyriopoulos IJ, Ginis A, Athanasakis K. Losing a foot versus losing a dollar; a systematic review of cost studies in diabetic foot complications. Expert Rev Pharmacoecon Outcomes Res 2017; 17:165-180. [DOI: 10.1080/14737167.2017.1305891] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ioannis Petrakis
- National School of Public Health, Health Economics Department, Athens, Greece
| | - Ilias J Kyriopoulos
- National School of Public Health, Health Economics Department, Athens, Greece
| | | | - Kostas Athanasakis
- National School of Public Health, Health Economics Department, Athens, Greece
| |
Collapse
|
10
|
Capobianco CM, Zgonis T. Soft Tissue Reconstruction Pyramid for the Diabetic Charcot Foot. Clin Podiatr Med Surg 2017; 34:69-76. [PMID: 27865316 DOI: 10.1016/j.cpm.2016.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Foot and ankle ulcerations in patients with diabetic Charcot neuroarthropathy (DCN) occur frequently and can be challenging to address surgically when conservative care fails. Patients with acute or chronic diabetic foot ulcers (DFU) are at continued risk for development of osteomyelitis, septic arthritis, gas gangrene, and potential lower extremity amputation. Concurrent vasculopathy and peripheral neuropathy as well as uncontrolled medical comorbidities complicate the treatment approach. In addition, pathomechanical forces left untreated may contribute to DFU recurrence in this patient population. This article outlines in detail the stepwise approach and options available for durable soft tissue coverage in the DCN patient.
Collapse
Affiliation(s)
- Claire M Capobianco
- Orthopaedic Associates of Southern Delaware, 1539 Savannah Road, Suite 203, Lewes, DE 19958, USA.
| | - Thomas Zgonis
- Division of Podiatric Medicine and Surgery, Department of Orthopaedics, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC 7776, San Antonio, TX 78229, USA
| |
Collapse
|
11
|
Roth-Albin I, Mai SHC, Ahmed Z, Cheng J, Choong K, Mayer PV. Outcomes Following Advanced Wound Care for Diabetic Foot Ulcers: A Canadian Study. Can J Diabetes 2016; 41:26-32. [PMID: 27634016 DOI: 10.1016/j.jcjd.2016.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/21/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Data concerning outcomes of Canadian patients with diabetic foot ulcers (DFUs) are limited. The objectives of this study were to evaluate the healing rates and identify the predictors of poor outcomes following advanced wound care in patients presenting with DFUs. METHODS We conducted retrospective cohort study of adult patients who had DFUs and were referred to a single Canadian advanced diabetic foot and wound care centre between January 1, 2010, and December 31, 2010. The primary outcome was the healing rate at 52 weeks. The generalized estimating equation model was used to identify potential risk factors associated with delayed healing of DFUs. RESULTS Of the 40 patients for whom there were complete follow ups, 35 (87.5%) had healing of all DFUs by 52 weeks. Predictors of poor healing were the presence of chronic ulcers, ulcer sizes >1 cm2, peripheral vascular disease and multiple ulcers at first presentation. Of the patients, 7.1% required amputation, and 8.9% of patients receiving our treatment died before 52 weeks. At 52 weeks of follow up, 16 of 17 recurrent ulcers and 68 of 108 pre-existing ulcers had healed. Compared to the unadjusted healing rate of preexisting ulcers (63.0%), the unadjusted healing rate of recurrent ulcers (94.1%) was significantly higher (p=0.01). CONCLUSIONS Our findings demonstrate that patients with DFUs in Canada who receive early and continued care from specialized, outpatient, advanced wound care centres experience significantly improved rates of healing of recurrent DFUs compared to pre-existing DFUs.
Collapse
Affiliation(s)
| | - Safiah H C Mai
- Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Zeeshan Ahmed
- Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ji Cheng
- Biostatistics Unit, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Karen Choong
- Department of Pediatrics, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
12
|
Formosa C, Gatt A, Chockalingam N. A Critical Evaluation of Existing Diabetic Foot Screening Guidelines. Rev Diabet Stud 2016; 13:158-186. [PMID: 28012281 PMCID: PMC5553765 DOI: 10.1900/rds.2016.13.158] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/19/2015] [Accepted: 10/25/2015] [Indexed: 12/15/2022] Open
Abstract
AIM To evaluate critically the current guidelines for foot screening in patients with diabetes, and to examine their relevance in terms of advancement in clinical practice, improvement in technology, and change in socio-cultural structure. METHODS A structured literature search was conducted in Pubmed/Medline, CINAHL, Cochrane Register of Controlled Trials, and Google between January 2011 and January 2015 using the keywords '(Diabetes) AND (Foot Screening) AND (Guidelines)'. RESULTS Ten complete diabetes foot screening guidelines were identified and selected for analysis. Six of them included the full-process guidelines recommended by the International Diabetes Federation. Evaluation of the existing diabetes foot screening guidelines showed substantial variability in terms of different evidence-based methods and grading systems to achieve targets, making it difficult to compare the guidelines. In some of the guidelines, it is unclear how the authors have derived the recommendations, i.e. on which study results they are based, making it difficult for the users to understand them. CONCLUSIONS Limitations of currently available guidelines and lack of evidence on which the guidelines are based are responsible for the current gaps between guidelines, standard clinical practice, and development of complications. For the development of standard recommendations and everyday clinical practice, it will be necessary to pay more attention to both the limitations of guidelines and the underlying evidence.
Collapse
Affiliation(s)
- Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida, MSD 2080, Malta
- Faculty of Health Sciences, Staffordshire University, UK
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida, MSD 2080, Malta
- Faculty of Health Sciences, Staffordshire University, UK
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida, MSD 2080, Malta
- Faculty of Health Sciences, Staffordshire University, UK
| |
Collapse
|
13
|
Diabetes foot complication: assessing primary and secondary outcomes of multidisciplinary team versus standard care (a systematic review). Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0422-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
14
|
Thewjitcharoen Y, Krittiyawong S, Porramatikul S, Parksook W, Chatapat L, Watchareejirachot O, Sripatpong J, Himathongkam T. Outcomes of hospitalized diabetic foot patients in a multi-disciplinary team setting: Thailand's experience. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2014; 1:187-191. [PMID: 29159100 PMCID: PMC5685051 DOI: 10.1016/j.jcte.2014.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 12/13/2022]
Abstract
Aims The aims of this study were to evaluate the outcomes of treatment among hospitalized patients with diabetic foot ulcers, the risk factors for non-healing ulcers, and the rate of major amputation among Thai patients. Methods A retrospective study of hospitalized diabetic foot patients treated at Theptarin Hospital during the period of 2009–2013. The complete healing rate was assessed at 12 months after admission. Results During the study period, 232 patients (123 males and 109 females) with 262 admissions were included (mean age 65.6 ± 11.9 years, mean duration of diabetes 17.2 ± 9.9 years) with a mean follow-up of 17.5 ± 16.7 months. Major amputations were performed in 4.2% of the patients and peripheral vascular disease (PVD) was a predictive factor (OR 5.25; 95% CI [1.43–19.29]; p-value 0.006). Complete healing (including minor amputations) was achieved in 82.1% of the admissions. Only DFU of the heel was a statistically significant (OR 3.34; 95% CI [1.11–10.24]; p-value 0.041) predictor of non-healing ulcers. Three patients (1.1%) died during hospitalization. Conclusions Management of diabetes-related foot ulcers with a multidisciplinary approach resulted in a limb salvage rate that was greater than 90% and a complete healing rate that was greater than 80%. Successful management of diabetic foot ulcers might be possible in Thailand utilizing this approach.
Collapse
Affiliation(s)
- Yotsapon Thewjitcharoen
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Sirinate Krittiyawong
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Sriurai Porramatikul
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Wyn Parksook
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Lapakorn Chatapat
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Orawan Watchareejirachot
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Jeeraphan Sripatpong
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | - Thep Himathongkam
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| |
Collapse
|
15
|
Exploring the concept of a team approach to wound care: Managing wounds as a team. J Wound Care 2014; 23 Suppl 5b:S1-S38. [DOI: 10.12968/jowc.2014.23.sup5b.s1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
16
|
Uzun G, Mutluoğlu M, Karagöz H, Memiş A, Karabacak E, Ay H. Pitfalls of Intralesional Ozone Injection in Diabetic Foot Ulcers: A Case Study. J Am Coll Clin Wound Spec 2014. [PMID: 26199878 DOI: 10.1016/j.jccw.2014.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Although the history of ozone therapy dates back to the 19th century, its use has shown a rapid growth of interest in recent decades. Intralesional ozone injection is seldom performed and its safety has not yet been reliably assessed for the treatment of diabetic foot wounds. Herein, we describe a diabetic patient who developed severe foot necrosis and infection after receiving intralesional ozone injections for a non-healing wound.
Collapse
Affiliation(s)
- Günalp Uzun
- Department of Underwater and Hyperbaric Medicine, Gülhane Military Medical Academy Haydarpaşa Teaching Hospital, Üsküdar, İstanbul 34668, Turkey
| | - Mesut Mutluoğlu
- Department of Underwater and Hyperbaric Medicine, Gülhane Military Medical Academy Haydarpaşa Teaching Hospital, Üsküdar, İstanbul 34668, Turkey
| | - Hüseyin Karagöz
- Department of Plastic and Reconstructive Surgery, Gülhane Military Medical Academy Haydarpaşa Teaching Hospital, Üsküdar, İstanbul, Turkey
| | - Ali Memiş
- Department of Underwater and Hyperbaric Medicine, Gülhane Military Medical Academy Haydarpaşa Teaching Hospital, Üsküdar, İstanbul 34668, Turkey
| | - Ercan Karabacak
- Department of Dermatology, Gülhane Military Medical Academy Haydarpaşa Teaching Hospital, Üsküdar, İstanbul, Turkey
| | - Hakan Ay
- Department of Underwater and Hyperbaric Medicine, Gülhane Military Medical Academy Haydarpaşa Teaching Hospital, Üsküdar, İstanbul 34668, Turkey
| |
Collapse
|
17
|
Kulkantrakorn K, Lorsuwansiri C. Sensory profile and its impact on quality of life in patients with painful diabetic polyneuropathy. J Neurosci Rural Pract 2013; 4:267-70. [PMID: 24250157 PMCID: PMC3821410 DOI: 10.4103/0976-3147.118766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Context: Painful diabetic polyneuropathy (PDN) is common and causes significant disability. The sensory profile in each patient is different and affects quality of life. Aim: To describe the demographic, details of sensory profile and its impact on quality of life in patients with PDN. Settings and Design: A cross-sectional survey in patients with PDN who were treated in a University Hospital. Materials and Methods: They were interviewed with standard questionnaires, which included neuropathic pain scale (NPS), a short-form McGill Pain Questionnaire (SF-MPQ) and a short form-36 quality of life survey (SF-36). Statistical Analysis Used: Descriptive statistics were used in demographic data. Student's t test was used to analyze continuous data. Multiple comparisons for proportions and correlations were made using Fisher Exact test and Pearson's coefficient of correlation, respectively. Results: Thirty three patients were included in this study. In NPS, sharp pain was the most common symptom and itching was the least common. Almost all patients had more than one type of pain. The mean VAS was 53 mm. In SFMPQ, the sensory score, affective score and the present pain score fell in the moderate range. In SF-36, physical functioning was the most affected and social function was the least affected. Conclusions: PDN significantly affects patients’ quality of life, especially physical function and role limitation due to a physical problem. Almost all patients have many types of pain and sharp pain is the most common.
Collapse
Affiliation(s)
- Kongkiat Kulkantrakorn
- Department of Internal Medicine, Faculty of Medicine, Thammasat University Rangsit Campus, Pathumthani, Thailand
| | | |
Collapse
|
18
|
Aalaa M, Malazy OT, Sanjari M, Peimani M, Mohajeri-Tehrani MR. Nurses' role in diabetic foot prevention and care; a review. J Diabetes Metab Disord 2012; 11:24. [PMID: 23497582 PMCID: PMC3598173 DOI: 10.1186/2251-6581-11-24] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 12/14/2022]
Abstract
Diabetes as one of Non-communicable diseases has allocated a large proportion of cost, time and human resources of health systems. Now, due to changes in lifestyle and industrial process, incidence of diabetes and its complications have been increased. Accordingly diabetic foot considered as a common complication of diabetes.Nurses are health care providers who actively involved in prevention and early detection of diabetes and its complications. The nurses' role could be in health care, health, community education, health systems management, patient care and improving the quality of life.Diabetes Nurses play their educating role in the field of prevention of diabetic foot, foot care and preventing from foot injury. In care dimension, nurses responsible for early detection of any changes in skin and foot sensation, foot care, dressing and apply novel technology.In the area of rehabilitation, help patient sufferings from diabetic foot ulcer or amputation, to have movement are diabetes nurse's duties.Consequently, nurses need to attend in special training to use the latest instructions of diabetic foot care in order that provides the effective services to facilitate promote diabetic patients health.
Collapse
Affiliation(s)
- M Aalaa
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - O Tabatabaei Malazy
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Sanjari
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Peimani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - MR Mohajeri-Tehrani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
19
|
Hogg FRA, Peach G, Price P, Thompson MM, Hinchliffe RJ. Measures of health-related quality of life in diabetes-related foot disease: a systematic review. Diabetologia 2012; 55:552-65. [PMID: 22246373 DOI: 10.1007/s00125-011-2372-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 09/20/2011] [Indexed: 10/14/2022]
Abstract
AIMS/HYPOTHESIS Patient-reported outcome measures (PROMs) are increasingly used as key performance indicators in chronic illness. We sought to review the value of these tools in assessing health-related quality of life (HRQOL) in patients with diabetes-related foot disease and identify the impact of each foot problem on life quality. METHODS A systematic review of literature on HRQOL PROMs in diabetes-related foot disease was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The quality of eligible studies was evaluated within pre-existing criteria. RESULTS 53 studies written between 1995 and 2010 met the inclusion criteria. A variety of HRQOL PROMs were used. Disease-specific tools were better than generic at quantifying temporal changes in life quality and showed greater sensitivity to ulcer/neuropathic severity. No studies have simultaneously evaluated disease-specific tools. Generic and utility HRQOL PROMs are frequently used as secondary outcome measures in randomised trials and cost-utility analysis. HRQOL is depressed in diabetes, further impaired by the presence of foot disease. Ulcer healing is associated with improvements in HRQOL. Patients with active ulceration report poorer HRQOL than those whom have undergone successful minor lower extremity amputation (LEA) but there is a paucity of quality data on HRQOL outcomes for diabetes-related LEA. CONCLUSIONS/INTERPRETATION No one PROM was identified as a 'gold standard' for assessing HRQOL in diabetes-related foot disease. Specific areas for further development include the most valid HRQOL PROM with disease-specific content; HRQOL outcomes in minor and major amputations and the role of HRQOL tools in routine clinical care.
Collapse
Affiliation(s)
- F R A Hogg
- St George's Vascular Institute, St James Wing, St George's Healthcare NHS Trust, 4th Floor, Blackshaw Road, London SW17 0QT, UK
| | | | | | | | | |
Collapse
|
20
|
de Bruin SR, Heijink R, Lemmens LC, Struijs JN, Baan CA. Impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: A systematic review of the literature. Health Policy 2011; 101:105-21. [DOI: 10.1016/j.healthpol.2011.03.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 03/15/2011] [Accepted: 03/28/2011] [Indexed: 11/29/2022]
|
21
|
Rerkasem K. Seminar Review: Sociocultural Practices and Epidemiology of Diabetic Foot Problem: Lessons From a Study in Chiang Mai University Hospital, Thailand. INT J LOW EXTR WOUND 2011; 10:86-90. [DOI: 10.1177/1534734611406102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The data on sociocultural practices and epidemiology of diabetic foot problems are scarce in Thailand. This report used data found in a database with patients involved in multidisciplinary foot care. Of the 511 patients with diabetes, 475 (93.0%) patients had type 2 diabetes. The prevalence of foot ulcers in diabetic patients was 12.5% and the amputation rate was 1.4%. A total of 32.7% of patients suffered from neuropathic problems. Barefoot walking inside the house was found 55.4% of the time, and this seemed to link closely with Thai sociocultural practices. Improvement in foot care was a direct result of foot care education.
Collapse
|
22
|
Abstract
Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non-weight bearing, all of which have been shown to adversely affect the patient's quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient's best interest and is crucial for resolution of the chronic nonhealing wound. The options for soft tissue coverage and the logical progression of application of these techniques in the diabetic foot will be described.
Collapse
Affiliation(s)
- Claire M Capobianco
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | | |
Collapse
|