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Cavero-Redondo I, Martínez-García I, Saz-Lara A, Garcia-Klepzig JL, Álvarez-Bueno C, Martínez-Vizcaino V. Comparative effect of different physical exercise training on exercise capacity and cardiac function in heart failure with preserved ejection fraction: a network meta-analysis-ExIC-FEp Study. Eur J Cardiovasc Nurs 2023; 22:669-678. [PMID: 36718092 DOI: 10.1093/eurjcn/zvad018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
AIMS This network meta-analysis aimed to compare the effect of different types of physical exercise [endurance training, endurance/resistance training, and high-intensity interval training (HIIT)] on exercise capacity and cardiac function parameters in patients with heart failure with preserved ejection fraction. METHODS AND RESULTS A systematic search of the MEDLINE (via PubMed), Scopus, and Web of Science databases was conducted to identify experimental studies addressing the effect of different physical exercise training programmes on exercise capacity and cardiac function in heart failure with preserved ejection fraction. Comparative evaluation of the effect of exercise training type was performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between exercise training types and controls/non-interventions. Eleven studies were included in the analysis showing that endurance training improves the main exercise capacity parameters (VO2peak, workload, exercise time, peak heart rate, VO2, and 6 min walk distance). Additionally, endurance/resistance training showed a significant effect on VO2peak, workload, early mitral annulus velocity, and early mitral/mitral annulus velocity ratio. Finally, HIIT showed a significant effect on VO2peak, VO2, and the early mitral/mitral annulus velocity ratio. CONCLUSION Our findings support the effect of three different types of physical exercise on exercise capacity, mainly VO2peak. Additionally, endurance/resistance training and HIIT could reverse left ventricular remodelling in patients with heart failure with preserved ejection fraction. REGISTRATION PROSPERO: CRD42021276111.
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Affiliation(s)
- Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | | | - Alicia Saz-Lara
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
| | | | - Celia Álvarez-Bueno
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Vicente Martínez-Vizcaino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
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2
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Bouillet B, Ahluwalia R, Iacopi E, Garcia-Klepzig JL, Lüdemann C, Manu C, Meloni M, Saenz De Buruaga VR, Vouillarmet J, Petit JM, Van Acker K, Lázaro-Martínez JL. Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays. J Wound Care 2021; 30:804-808. [PMID: 34644141 DOI: 10.12968/jowc.2021.30.10.804] [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] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. METHOD In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. RESULTS Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004). CONCLUSION The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Benjamin Bouillet
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Dijon, France.,Unité INSERM, LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | | | - Elisabetta Iacopi
- University of Pisa, Ospedale di Cisanello, via Paradisa 2, 56126 Pisa, Italy
| | | | - Claas Lüdemann
- Franziskus Krankenhaus Berlin, Budapester Strasse, 15-19, 10787 Berlin, Germany
| | - Chris Manu
- King's College Hospital, Denmark Hill, London, UK
| | - Marco Meloni
- University of Roma Tor Vergata, Viale Oxford 81, 00133 Roma, Italy
| | | | - Julien Vouillarmet
- CHU Lyon Sud, Pavillon Médical, 165 chemin du Grand Revoyet 69495 Pierre Bénite, France
| | - Jean-Michel Petit
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Dijon, France.,Unité INSERM, LNC-UMR 1231, Université de Bourgogne, Dijon, France
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3
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Meloni M, Lazaro-Martínez JL, Ahluwalia R, Bouillet B, Izzo V, Di Venanzio M, Iacopi E, Manu C, Garcia-Klepzig JL, Sánchez-Ríos JP, Lüedemann C, De Buruaga VRS, Vouillarmet J, Guillaumat J, Aleandri AR, Giurato L, Edmonds M, Piaggesi A, Van Acker K, Uccioli L. Effectiveness of fast-track pathway for diabetic foot ulcerations. Acta Diabetol 2021; 58:1351-1358. [PMID: 33942178 PMCID: PMC8413149 DOI: 10.1007/s00592-021-01721-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 01/22/2023]
Abstract
AIM To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. METHODS The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. RESULTS Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. CONCLUSION After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.
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Affiliation(s)
- Marco Meloni
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | | | - Raju Ahluwalia
- Department of Trauma and Ortophaedic Department, King ́s College Hospital, London, UK
| | | | - Valentina Izzo
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | - Elisabetta Iacopi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | - Chris Manu
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | | | | | | | | | | | | | | | - Laura Giurato
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Micheal Edmonds
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | - Alberto Piaggesi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | | | - Luigi Uccioli
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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Loureiro-Amigo J, Suárez-Carantoña C, Oriol-Bermúdez I, Sánchez-Díaz C, Coloma-Conde A, Manzano-Espinosa L, Rubio-Rivas M, Otero-Perpiñá B, Jenaro MMFM, Coduras-Erdozain A, Garcia-Klepzig JL, Vargas-Parra D, Pesqueira-Fontán PM, Fiteni-Mera I, García-García GM, Jiménez-Torres J, Rodríguez-Cortés P, Costo-Muriel C, Arnalich-Fernández F, Artero A, Carrasco-Sánchez FJ, Escobar-Sevilla J, Alcalá-Pedrajas JN, Gómez-Huelgas R, Ramos-Rincón JM. Prone Position in COVID-19 Patients With Severe Acute Respiratory Distress Syndrome Receiving Conventional Oxygen Therapy: A Retrospective Study. Arch Bronconeumol 2021; 58:277-280. [PMID: 34121796 PMCID: PMC8180347 DOI: 10.1016/j.arbres.2021.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Jose Loureiro-Amigo
- Infectious Diseases Unit - Internal Medicine Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Cecilia Suárez-Carantoña
- Internal Medicine Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Isabel Oriol-Bermúdez
- Infectious Diseases Unit - Internal Medicine Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Cristina Sánchez-Díaz
- Internal Medicine Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ana Coloma-Conde
- Infectious Diseases Unit - Internal Medicine Department, Moisès Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Luis Manzano-Espinosa
- Internal Medicine Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain
| | | | | | | | | | - Derly Vargas-Parra
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Paula M Pesqueira-Fontán
- Internal Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - José Jiménez-Torres
- Unidad de Gestión Clínica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba, Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | | | - Clara Costo-Muriel
- Internal Medicine Department, Regional University Hospital of Málaga, Málaga, Spain
| | | | - Arturo Artero
- Internal Medicine Department, Dr. Peset University Hospital, Valencia, Spain
| | | | | | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
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Garcia-Klepzig JL, Sánchez-Ríos JP, Manu C, Ahluwalia R, Lüdemann C, Meloni M, Lacopi E, De Buruaga VRS, Bouillet B, Vouillarmet J, Lázaro-Martínez JL, Van Acker K. Perception of diabetic foot ulcers among general practitioners in four European countries: knowledge, skills and urgency. J Wound Care 2019; 27:310-319. [PMID: 29738299 DOI: 10.12968/jowc.2018.27.5.310] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 01/13/2023]
Abstract
OBJECTIVE Diabetic foot ulcers (DFU) have the potential to deteriorate rapidly, in the absence of prompt assessment and treatment. The aim of this study was to analyse the awareness and perception of DFU among general practitioners (GPs) from four European countries, and to find possible differences between these countries in terms of management. METHOD A two-part, quantitative, online questionnaire was distributed to GPs across four countries in Europe-the UK, France, Germany and Spain. The first part entailed a survey on the perception and knowledge of the pathogenesis and management of DFU, among GPs. The second part of the questionnaire was used for the collection of data on recently-managed DFU cases. RESULTS For the first part of the study, 600 questionnaires were collected (150 per country) and 1188 patient cases of DFU management were included in the second part. In France, only 49% of GPs mentioned neuropathy as the main causative process in DFU development. However, in Germany and the UK, 82% and 83% of GPs, respectively, considered neuropathy as an important causative factor. DFU care in Spain and the UK is thought to be organised by multidisciplinary teams (MDT) (83% and 84% of GPs, respectively, completely agreed with this statement). In France and Germany, GPs are responsible for follow-up and management. Only UK physicians have clearly identified specialised podiatrists to refer patients to, if needed. Approximately 29-40% of GPs in all countries did not feel they were sufficiently trained in the DFU treatment protocol. Almost 30% of GPs in France and Germany thought that DFU treatment was not well-established due to the absence of clinical guidelines and protocols. CONCLUSION The intra-country and inter-country management of the complex aspects of DFU is quite heterogeneous. The cause of this finding is multifactorial. Although there are international guidelines, it would be beneficial to establish clear and specific competencies for the different health professionals involved in DFU management. As a minimum, intra-country heterogeneity should improve with their development.
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Affiliation(s)
- José Luis Garcia-Klepzig
- Internal Medicine Department, Hospital Clinico San Carlos De Madrid, Calle Profesor Martin Lagos, 28040 Madrid
| | | | - Chris Manu
- Diabetes Research Fellow; King's College Hospital, Denmark Hill, London
| | - Raju Ahluwalia
- Trauma and Ortophaedic Department, King´s College Hospital, London, UK
| | - Claas Lüdemann
- Franziskus Krankenhaus Berlin, Budapester Strasse, Berlin
| | - Marco Meloni
- Diabetic Foot Center, University of Roma Tor Vergata, Viale Oxford 81, Roma
| | - Elisabetta Lacopi
- Diabetic Foot Section, University of Pisa, Ospedale di Cisanello, via Paradisa 2, Pisa
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6
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Manu C, Lacopi E, Bouillet B, Vouillarmet J, Ahluwalia R, Lüdemann C, Garcia-Klepzig JL, Meloni M, De Buruaga VRS, Sánchez-Ríos JP, Edmonds M, Apelqvist J, Martinez JLL, Van Acker K. Delayed referral of patients with diabetic foot ulcers across Europe: patterns between primary care and specialised units. J Wound Care 2018; 27:186-192. [DOI: 10.12968/jowc.2018.27.3.186] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Chris Manu
- King's College Hospital, Denmark Hill, SE5 9RS London
| | - Elisabetta Lacopi
- University of Pisa, Ospedale di Cisanello, via Paradisa 2, 56126 Pisa
| | - Benjamin Bouillet
- CHU de Dijon, 2 boulevard Maréchal de Lattre de Tassigny, 21000 DIJON
| | - Julien Vouillarmet
- JCHU Lyon Sud, Pavillon Médical, 165 chemin du Grand Revoyet 69495 Pierre Bénite
| | | | - Claas Lüdemann
- Franziskus Krankenhaus Berlin, Budapester Strasse, 15-19, 10787 BERLIN
| | | | - Marco Meloni
- University of Roma Tor Vergata, Viale Oxford 81, 00133 Roma
| | | | | | - Mike Edmonds
- King's College Hospital, Denmark Hill, SE5 9RS London
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, S-205 02 Malmö, Sweden
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