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Guan H, Wang Y, Niu P, Zhang Y, Zhang Y, Miao R, Fang X, Yin R, Zhao S, Liu J, Tian J. The role of machine learning in advancing diabetic foot: a review. Front Endocrinol (Lausanne) 2024; 15:1325434. [PMID: 38742201 PMCID: PMC11089132 DOI: 10.3389/fendo.2024.1325434] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Background Diabetic foot complications impose a significant strain on healthcare systems worldwide, acting as a principal cause of morbidity and mortality in individuals with diabetes mellitus. While traditional methods in diagnosing and treating these conditions have faced limitations, the emergence of Machine Learning (ML) technologies heralds a new era, offering the promise of revolutionizing diabetic foot care through enhanced precision and tailored treatment strategies. Objective This review aims to explore the transformative impact of ML on managing diabetic foot complications, highlighting its potential to advance diagnostic accuracy and therapeutic approaches by leveraging developments in medical imaging, biomarker detection, and clinical biomechanics. Methods A meticulous literature search was executed across PubMed, Scopus, and Google Scholar databases to identify pertinent articles published up to March 2024. The search strategy was carefully crafted, employing a combination of keywords such as "Machine Learning," "Diabetic Foot," "Diabetic Foot Ulcers," "Diabetic Foot Care," "Artificial Intelligence," and "Predictive Modeling." This review offers an in-depth analysis of the foundational principles and algorithms that constitute ML, placing a special emphasis on their relevance to the medical sciences, particularly within the specialized domain of diabetic foot pathology. Through the incorporation of illustrative case studies and schematic diagrams, the review endeavors to elucidate the intricate computational methodologies involved. Results ML has proven to be invaluable in deriving critical insights from complex datasets, enhancing both the diagnostic precision and therapeutic planning for diabetic foot management. This review highlights the efficacy of ML in clinical decision-making, underscored by comparative analyses of ML algorithms in prognostic assessments and diagnostic applications within diabetic foot care. Conclusion The review culminates in a prospective assessment of the trajectory of ML applications in the realm of diabetic foot care. We believe that despite challenges such as computational limitations and ethical considerations, ML remains at the forefront of revolutionizing treatment paradigms for the management of diabetic foot complications that are globally applicable and precision-oriented. This technological evolution heralds unprecedented possibilities for treatment and opportunities for enhancing patient care.
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Affiliation(s)
- Huifang Guan
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Ying Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Ping Niu
- Department of Encephalopathy, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yuxin Zhang
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanjiao Zhang
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Runyu Miao
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinyi Fang
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruiyang Yin
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shuang Zhao
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Jun Liu
- Department of Hand Surgery, Second Hospital of Jilin University, Changchun, China
| | - Jiaxing Tian
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Lv X, Zhao N, Long S, Wang G, Ran X, Gao J, Wang J, Wang T. 3D skin bioprinting as promising therapeutic strategy for radiation-associated skin injuries. Wound Repair Regen 2024. [PMID: 38602068 DOI: 10.1111/wrr.13181] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/16/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
Both cutaneous radiation injury and radiation combined injury (RCI) could have serious skin traumas, which are collectively referred to as radiation-associated skin injuries in this paper. These two types of skin injuries require special managements of wounds, and the therapeutic effects still need to be further improved. Cutaneous radiation injuries are common in both radiotherapy patients and victims of radioactive source accidents, which could lead to skin necrosis and ulcers in serious conditions. At present, there are still many challenges in management of cutaneous radiation injuries including early diagnosis, lesion assessment, and treatment prognosis. Radiation combined injuries are special and important issues in severe nuclear accidents, which often accompanied by serious skin traumas. Mass victims of RCI would be the focus of public health concern. Three-dimensional (3D) bioprinting, as a versatile and favourable technique, offers effective approaches to fabricate biomimetic architectures with bioactivity, which provides potentials for resolve the challenges in treating radiation-associated skin injuries. Combining with the cutting-edge advances in 3D skin bioprinting, the authors analyse the damage characteristics of skin wounds in both cutaneous radiation injury and RCI and look forward to the potential value of 3D skin bioprinting for the treatments of radiation-associated skin injuries.
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Affiliation(s)
- Xiaofan Lv
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Na Zhao
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
- Institute of Materia Medica and Department of Pharmaceutics, College of Pharmacy, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuang Long
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Guojian Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xinze Ran
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jining Gao
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Junping Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Tao Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
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Wu Y, Wu L, Yu M. The clinical value of intelligent wound measurement devices in patients with chronic wounds: A scoping review. Int Wound J 2024; 21:e14843. [PMID: 38494195 PMCID: PMC10944690 DOI: 10.1111/iwj.14843] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Chronic wounds are common in clinical practice, with long treatment cycle and high treatment cost. Changes in wound area can well predict the effectiveness of treatment and the possibility of healing. Therefore, continuous wound monitoring and evaluation are particularly important. Traditional manual wound measurement tends to overestimate wound area. Recently, various intelligent wound measurement devices have been introduced into clinical practice. This review aims to summarise the reliability, validity, types and measurement principles of different intelligent wound measurement devices, so as to analyse the clinical value and application prospect. Articles numbering 2610 were retrieved from the database, and 14 articles met the inclusion criteria. The results showed that the intelligent wound measurement devices included in the study reported good reliability and validity. Contact devices can lead to wound bed damage, wound deformation, patient pain, and is not convenient for electronic wound recording; partial contact devices can complete continuous monitoring and recording of wounds, but are not sensitive to wound depth measurement. Non-contact devices are more accurate in capturing wound images. In addition to wound measurement, they also have the function of wound assessment. In general, handheld and portable non-contact devices have great clinical value and promotion prospects.
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Affiliation(s)
- Yujie Wu
- Department of Nursing, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Liping Wu
- Department of NursingChildren's Hospital of Chongqing Medical UniversityChongqingChina
| | - Mingfeng Yu
- Department of Nursing, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Alcântara SBC, de Araújo JG, Santos DF, da Silva TR, Goulart IMB, Bernardes da Silva AM, Antunes DE. Identification of types of wound bed tissue as a percentage and total wound area by planimetry in neuropathic and venous ulcers. J Vasc Nurs 2023; 41:164-170. [PMID: 38072568 DOI: 10.1016/j.jvn.2023.06.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/13/2023] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Neuropathic and venous leg ulcers are chronic wounds associated with devitalized tissue and recurrent infection. Management should be guided by accurate tissue assessment, including the use of planimetry, which provides tissue types as a percentage of the total wound bed surface area. OBJECTIVE This innovative study aimed to assess and identify the wound bed tissues, as a percentage, of neuropathic and venous ulcers using digital planimetry, providing support to nurses optimize the management of necrotic tissues and, consequently, to avoid wound infection. METHODS This cross-sectional study enrolled 24 patients with chronic wounds who were assessed from January to March 2021 at the Wound Outpatients Clinic. The wound photographs were analyzed using Image J 1.53e and a smartphone with WoundDoc Plus® 2.8.2 via digital planimetry. Statistical analyses were performed using the binomial test, t-test, and Mann-Whitney. RESULTS Median wound areas (p=0.3263) did not differ between the group with 2 or 3 risk factors for delayed healing (Md: 31.7) and the group with up to 1 risk factor (Md: 5.3). A low exudate level was associated with the up-to-1-risk-factor-for-delayed-healing group (p=0.0405), while a medium level was associated with the two-or-three-risk-factor group (p=0.0247). A heat map displayed the tissue percentages in the wound bed. In the group with 2 or 3 risk factors for delayed healing, 91.7% (11/12) had less than 70% granulation tissue, which was the primary factor for this group (p<0.0001). Additionally, 66.7% (8/12) of patients with 2 or 3 risk factors for delayed healing exhibited discolored and/or dark red granulation tissue as the primary factor (p=0.0130). CONCLUSION This novel identification of wound area and tissue types as a percentage, using digital planimetry, can play a crucial role in assisting nurses in decision-making related to the appropriate management of devitalized tissues. Furthermore, this measurements may facilitate the conducting of virtual wound consultations and offer valuable support in the development of protocols aimed at preventing infection and biofilm formation in the wound bed.
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Affiliation(s)
- Silvia Bottaro Carvalho Alcântara
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil
| | - Juliano Gonçalves de Araújo
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil
| | - Diogo Fernandes Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil; School of Medicine, Federal University of Uberlândia, Uberlândia, MG 38400-902, Brazil
| | | | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil; Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia, Uberlândia, MG 38400-902, Brazil
| | | | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil.
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Dolibog PT, Dolibog P, Chmielewska D. Determining the measurement accuracy in assessing the progress of wound healing. Postepy Dermatol Alergol 2023; 40:554-560. [PMID: 37692269 PMCID: PMC10485759 DOI: 10.5114/ada.2023.129326] [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: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Wound management is a challenge in terms of the way, duration and cost of treatment both for the patient and health providers. The healing of skin wounds is a highly multi-step coordinated process. Objective monitoring of treatment at every stage is necessary to assess the applied therapy. Aim To show the possibility of using the AutoCad software (ACS) as a tool with a slight measurement error for accurate measurement of the venous leg ulcers on the lower limbs. Material and methods To determine the error of the measurement method Circle Templates For Drafting for four different sizes were used as ulcer models. Seventy-six wounds of various sizes from patients with venous leg ulcers (VLUs) were photographed and outlined with a marker on a transparent foil. The wounds were measured both using ACS and digital planimetry with C-Geo software (CGS). Data were analysed using Wilcoxon test, intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results The mean relative error of the surface wound model area measured by the ACS was 0.30 ±0.31% (range: 0.004-1.25) and a median of 0.18%. Areas and perimeters measured with ACS were higher than areas and perimeters measured with CGS, and the difference was statistically significant. Conclusions The analysis of the wound images obtained in the ACS showed a very high potential of the software in terms of the accuracy of the analysed areas, which significantly increases the possibility of the analysis and reduces the measurement error in relation to planimetry using a digital digitizer.
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Affiliation(s)
- Paweł T. Dolibog
- Department of Biophysics, Faculty of Medical Sciences, Medical University of Silesia, Zabrze, Poland
| | - Patrycja Dolibog
- Department of Medical Biophysics, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
| | - Daria Chmielewska
- Institute of Physiotherapy and Health Sciences, Electromyography and Pelvic Floor Muscles Laboratory, Department of Physical Medicine, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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6
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Neo NWS, Tho PC. Diagnostic accuracy and validity of image-assisted versus face-to-face wound assessments for the management of chronic wounds: a systematic review protocol. JBI Evid Synth 2022; 20:2572-2578. [PMID: 35972059 DOI: 10.11124/jbies-21-00293] [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] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This review aims to evaluate the accuracy and validity of diagnostic decisions derived from image-assisted wound assessments compared with face-to-face consultations for chronic wound care. INTRODUCTION Images are often used within the inpatient, outpatient, and community settings to facilitate interdisciplinary transfer of care, objective wound assessments, and accurate treatment decisions. An ever-changing and ever-improving selection of image-capturing devices has been created and studied in recent years. To improve future chronic wound care programs, there is a need to explore how accurately clinicians can diagnose specific wound characteristics using these images, especially when these devices are operated in the clinical setting. INCLUSION CRITERIA Peer-reviewed studies and unpublished/gray literature comparing image-assisted with face-to-face modalities for chronic wound care will be included. Chronic wounds include, but are not limited to, diabetic foot ulcers, ischemic lower limb ulcers, and pressure ulcers. Studies will be excluded if they examine acute wounds or if the reference standard is not face-to-face assessment. METHODS A comprehensive search of multiple databases and gray literature sources (MEDLINE, CINAHL, Embase, Web of Science, Scopus, Google Scholar, and ProQuest Central) will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature published from 2000 onward will be retrieved. Two reviewers will independently screen and appraise the articles. Data extraction and synthesis will be performed based on the JBI methodology for the conduct of diagnostic test accuracy systematic review. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021265679.
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Affiliation(s)
| | - Poh Chi Tho
- Evidence-Based Nursing Unit, National University Hospital, Singapore.,Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing: A JBI Centre of Excellence
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7
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Kuang B, Dean A, Frank G, Aitken SJ. Innovative and accessible multidisciplinary care is needed to improve diabetes-related foot disease outcomes in Australia and New Zealand. ANZ J Surg 2022; 92:644-645. [PMID: 35434956 DOI: 10.1111/ans.17582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Beatrice Kuang
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Anastasia Dean
- Auckland Regional Vascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Georgina Frank
- Sydney Local Health District Podiatry and High Risk Foot Services, Concord and Royal Prince Alfred Hospitals, Sydney, New South Wales, Australia
| | - Sarah Joy Aitken
- Concord Institute Academic Surgery, Vascular Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Lasschuit JWJ, Featherston J, Tonks KTT. Reliability of a Three-Dimensional Wound Camera and Correlation With Routine Ruler Measurement in Diabetes-Related Foot Ulceration. J Diabetes Sci Technol 2021; 15:1361-1367. [PMID: 33243005 PMCID: PMC8655280 DOI: 10.1177/1932296820974654] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND In an era of increasing technology and telehealth utilization, three-dimensional (3D) wound cameras promise reliable, rapid, and touch-free ulceration measurements. However, reliability data for commercially available devices in the diabetes foot service setting is lacking. We aimed to evaluate the reliability of diabetes-related foot ulceration measurement using a 3D wound camera in comparison to the routinely used ruler and probe. METHOD Participants were prospectively recruited from a tertiary interdisciplinary diabetes foot service. Ulcerations were measured at each visit by two blinded observers, first by ruler and probe, and then using a 3D wound camera twice. Reliability was evaluated using intraclass correlation coefficients (ICC). Measurement methods were compared by Pearson correlation. RESULTS Sixty-three ulcerations affecting 38 participants were measured over 122 visits. Interobserver reliability of ruler measurement was excellent for estimated area (ICC 0.98, 95% CI 0.97-0.98) and depth (ICC 0.93, 95% CI 0.90-0.95). Intraobserver and interobserver reliability of the 3D wound camera area was excellent (ICC 0.96, 95%CI 0.95-0.97 and 0.97 95% CI 0.96-0.98, respectively). Depth was unrecordable in over half of 3D wound camera measurements, and reliability was inferior to probe measurement. Area correlation between methods was good (R = 0.88 and 0.94 per observer); however, depth correlation was poor (R = 0.49 and 0.65). CONCLUSIONS 3D wound cameras offer practical advantages over ruler-based measurement. In diabetes-related foot ulceration, the reliability and comparability of area measurement was excellent across both methods, although depth was more reliably obtained by the probe. These limitations, together with cost, are important considerations if implementing this technology in diabetes foot care.
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Affiliation(s)
- Joel Willem Johan Lasschuit
- Department of Endocrinology and
Diabetes, St Vincent’s Hospital, Sydney, New South Wales, Australia
- Healthy Ageing, Garvan Institute of
Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New
South Wales, Sydney, Sydney, New South Wales, Australia
- Dr Joel Willem Johan Lasschuit, BMedSc, MBBS
(Hons), FRACP, Diabetes Centre, Level 4, Garvan Institute of Medical Research,
384 Victoria Street, Darlinghurst, New South Wales 2010, Australia.
| | - Jill Featherston
- Department of Podiatry, St Vincent’s
Hospital, Sydney, New South Wales, Australia
- School of Medicine, Cardiff University,
Cardiff, Wales, UK
| | - Katherine Thuy Trang Tonks
- Department of Endocrinology and
Diabetes, St Vincent’s Hospital, Sydney, New South Wales, Australia
- Healthy Ageing, Garvan Institute of
Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New
South Wales, Sydney, Sydney, New South Wales, Australia
- School of Medicine, University of Notre
Dame, Sydney, New South Wales, Australia
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9
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Pena G, Kuang B, Edwards S, Cowled P, Dawson J, Fitridge R. Factors Associated With Key Outcomes in Diabetes Related Foot Disease: A Prospective Observational Study. Eur J Vasc Endovasc Surg 2021; 62:233-240. [PMID: 34024706 DOI: 10.1016/j.ejvs.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/26/2020] [Revised: 03/29/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Diabetic foot disease is a serious and common complication of diabetes mellitus. The aim of this study was to assess limb and patient factors associated with key clinical outcomes in diabetic patients with foot ulcers. METHODS This was a prospective observational study of diabetic patients with foot wounds admitted to a major tertiary teaching hospital in South Australia or seen at associated multidisciplinary foot clinics between February 2017 and December 2018. Patient demographic and clinical data were collected, including limb status severity assessed by the WIfI system and grip strength. Participants were followed up for 12 months. The primary outcomes were major amputation, death, amputation free survival, and completion of healing of the index wound within one year. RESULTS A total of 153 participants were recruited and outcome data were obtained for 152. Forty-two participants underwent revascularisation during the research period. Eighteen participants (11.8%) suffered major amputation of the index limb and 16 (10.5%) died during follow up. Complete wound healing was achieved in 106 (70%) participants. There was a statistically significant association between WIfI stage and major amputation (subdistribution hazard ratio [SHR] 2.75), mortality (hazard ratio [HR] 2.60), amputation free survival (odds ratio [OR] 0.32), and wound healing (SHR 0.69). There was also a statistically significant association between time to healing and grip strength (SHR 0.50), and previous amputations (major or minor) (SHR 0.57). CONCLUSION This prospective study supports the ability of the WIfI classification system to predict one year key clinical outcomes in a diabetic population with foot ulcers. It also demonstrated that grip strength may be a useful predictor of wound healing.
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Affiliation(s)
- Guilherme Pena
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
| | - Beatrice Kuang
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Suzanne Edwards
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prue Cowled
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Joseph Dawson
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Fitridge
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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10
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Abstract
BACKGROUND: Wound monitoring is very meaningful for the clinical research, diagnosis and treatment. But the existing wound monitoring technology is hard to meet the needs of modern medical care in terms of real-time, non-invasive and anti-interference. OBJECTIVE: To solve this problem, this paper proposed a new kind of monitoring technology based on the co-planar waveguide transmission line theory and assessed the application value of this method as a wound monitoring technology. METHODS: The simplified wound model included the skin, fat, muscle, tissue fluid and bandage and a new co-planar waveguide sensor were designed and established. All of the simulation was achieved in the electromagnetic special software. The data processing method was based on the transmission line theory. RESULTS: Detailed analyses of the results from the simulation were conducted. The sensor has a good monitoring effect in the low frequency band. The monitoring results could be influenced by the thickness of the bandage outside the wound. The thickness of the bandage should not be larger than 10 mm. The effective monitoring area of the sensor is 30 × 20 mm2. CONCLUSIONS: The proposed sensor based on the CPW transmission principle in this paper has good wound monitoring potential.
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Affiliation(s)
- Liang Zhang
- School of Basic Medical Science, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Zhenyu Ji
- Faculty of Military Biomedical Engineering, Air Force Military Medical University, Xi'an, Shaanxi, China
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11
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Kuang B, Pena G, Szpak Z, Edwards S, Battersby R, Cowled P, Dawson J, Fitridge R. Assessment of a smartphone-based application for diabetic foot ulcer measurement. Wound Repair Regen 2021; 29:460-465. [PMID: 33657252 DOI: 10.1111/wrr.12905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/28/2020] [Revised: 01/19/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022]
Abstract
The accurate measurement of diabetic foot ulcer (DFU) wound size is essential as the rate of wound healing is a significant prognostic indicator of the likelihood of complete wound healing. Mobile phone photography is often used for surveillance and to aid in telemedicine consultations. However, there remains no accurate and objective measurement of wound size integrated into these photos. The NDKare mobile phone application has been developed to address this need and our study evaluates its accuracy and practicality for DFU wound size assessment. The NDKare mobile phone application was evaluated for its accuracy in two- (2D) and three-dimensional (3D) wound measurement. One hundred and fifteen diabetic foot wounds were assessed for wound surface area, depth and volume accuracy in comparison to Visitrak and the WoundVue camera. Thirty five wounds had two assessors with different mobiles phones utilizing both applications to assess the reproducibility of the measurements. The 2D surface area measurements by NDKare showed excellent concordance with Visitrak and WoundVue measurements (ICC: 0.991 [95% CI: 0.988, 0.993]) and between different users (ICC: 0.98 [95% CI: 0.96, 0.99)]. The 3D NDKare measurements had good agreement for depth and fair agreement for volume with the WoundVue camera. The NDKare phone application can consistently and accurately obtain 2D measurements of diabetic foot wounds with mobile phone photography. This is a quick and readily accessible tool which can be integrated into comprehensive diabetic wound care.
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Affiliation(s)
- Beatrice Kuang
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Guilherme Pena
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Zygmunt Szpak
- Australian Institute for Machine Learning, The University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ruth Battersby
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Prue Cowled
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Division of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Joseph Dawson
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Robert Fitridge
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Division of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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