Showing posts with label diabetic foot. Show all posts
Showing posts with label diabetic foot. Show all posts

Monday, March 14, 2005

Qualitative research on diabetic foot ulcers

Medscape have a full text article on this (free registration required to access)
A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract
The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.

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Qualitative research on diabetic foot ulcers

Medscape have a full text article on this (free registration required to access)
A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract
The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.

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Sunday, February 27, 2005

New research should have impact on clinical practice

The latest Diabetes Care has two important papers:
Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton

OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.

A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton

OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers

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New research should have impact on clinical practice

The latest Diabetes Care has two important papers:
Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton

OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.

A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton

OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers

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Friday, January 28, 2005

Ischemic diabetic foot ulcers do respond to total contact casting

There has always been a reluctance to use total contact cats on diabetic ischemic ulcers. This latest study in Diabetes Care has shown that moderate ischaemic ulcers do respond:

Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study
Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C. Schaper
OBJECTIVE— A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.
RESEARCH DESIGN AND METHODS— Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.
RESULTS— Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P CONCLUSIONS— In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.

Discussion: Moderately ischemic diabetic foot ulcers do respond to TCC

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Ischemic diabetic foot ulcers do respond to total contact casting

There has always been a reluctance to use total contact cats on diabetic ischemic ulcers. This latest study in Diabetes Care has shown that moderate ischaemic ulcers do respond:

Total Contact Casting of the Diabetic Foot in Daily Practice A prospective follow-up study
Marrigje H. Nabuurs-Franssen, Ron Sleegers, Maya SP Huijberts, Wiel Wijnen, Antal P. Sanders, Geert Walenkamp and Nicolaas C. Schaper
OBJECTIVE— A limited number of clinical trials have shown that the total contact cast (TCC) is an effective treatment in neuropathic, noninfected, and nonischemic foot ulcers. In this prospective data collection study, we assessed outcome and complications of TCC treatment in neuropathic patients with and without peripheral arterial disease (PAD) or (superficial) infection.
RESEARCH DESIGN AND METHODS— Ninety-eight consecutive patients selected for casting were followed until healing; all had polyneuropathy, 44% had PAD, and 29% had infection. Primary outcomes were percentage healed with a cast, time to heal, and number of complications.
RESULTS— Ninety percent of all nonischemic ulcers without infection and 87% with infection healed in the cast (NS). In patients with PAD but without critical limb ischemia, 69% of the ulcers without infection and 36% with infection healed (P CONCLUSIONS— In comparison to pure neuropathic ulcers, ulcers with moderate ischemia or infection can be treated effectively with casting. However, when both PAD and infection are present or the patient has a heel ulcer, outcome is poor and alternative strategies should be sought. The high rate of preulcerative lesions stresses the importance of close monitoring during TCC treatment.

Discussion: Moderately ischemic diabetic foot ulcers do respond to TCC

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Friday, January 21, 2005

Interclinician variation in diabetes foot assessment- a national lottery?

From the latest Diabetic Medicine:

Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.
Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.
Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.
Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial asses

Discussion here.

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Interclinician variation in diabetes foot assessment- a national lottery?

From the latest Diabetic Medicine:

Interclinician variation in diabetes foot assessment- a national lottery?
L. Thompson, C. Nester, L. Stuart and P. Wiles
Aim The aim was to evaluate variation among clinicians in the outcome of assessments of foot health status and risk status in patients with diabetes.
Methods Seventeen clinicians assessed three patients with diabetes using a standardized assessment form and risk classification system.
Results There was variation among clinicians in all aspects of the assessment; recording basic demographic information; taking a medical history; vascular and neurological assessments. Variation was also evident in the risk categories allocated to each of the three patients.
Conclusions As a consequence of the variation among clinicians in the foot assessment the same patient would have received different care pathways to monitor and manage their foot health depending upon which clinician undertook their initial asses

Discussion here.

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Saturday, December 25, 2004

Diabetic Foot Natural History

Some pretty bold claims were made on altering the natural history of the diabetic foot in this paper: Changing the Natural History of Diabetic Neuropathy: Incidence of Ulcer/Amputation in the Contralateral Limb of Patients With a Unilateral Nerve Decompression Procedure (Ann Plast Surg. 2004 Dec;53(6):517-522 Aszmann O, Tassler PL, Dellon AL.). The authors claims that "decompression of lower extremity nerves in diabetic neuropathy changes the natural history of this disease, representing a paradigm shift in health care costs. " All this based on being able to help diabetic neuropathy with decompression surgery. Given that the etiological pathways of diabetic foot complications are so multifactorial - especially the role of vascular disease in amputations, I can't see how improving one factor represents a "paradigm shift". Dr Dellon is doing some good work and has a number of publications on decompression surgery to relieve pressure on nerves in those with diabetic peripheral neuropathy.

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Diabetic Foot Natural History

Some pretty bold claims were made on altering the natural history of the diabetic foot in this paper: Changing the Natural History of Diabetic Neuropathy: Incidence of Ulcer/Amputation in the Contralateral Limb of Patients With a Unilateral Nerve Decompression Procedure (Ann Plast Surg. 2004 Dec;53(6):517-522 Aszmann O, Tassler PL, Dellon AL.). The authors claims that "decompression of lower extremity nerves in diabetic neuropathy changes the natural history of this disease, representing a paradigm shift in health care costs. " All this based on being able to help diabetic neuropathy with decompression surgery. Given that the etiological pathways of diabetic foot complications are so multifactorial - especially the role of vascular disease in amputations, I can't see how improving one factor represents a "paradigm shift". Dr Dellon is doing some good work and has a number of publications on decompression surgery to relieve pressure on nerves in those with diabetic peripheral neuropathy.

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Monday, August 09, 2004

Diabetic Foot site

I have been tardy in updating here and at my Diabetic Foot site - just added a whole lot of new stuff - check it out here

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Diabetic Foot site

I have been tardy in updating here and at my Diabetic Foot site - just added a whole lot of new stuff - check it out here

Back to home

Monday, October 06, 2003

Charcot's neuroarthropathy:

All the latest information on Charcot's neuroarthropathy from ePodiatry for health professionals and on Charcot foot for those with diabetes.

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Charcot's neuroarthropathy:

All the latest information on Charcot's neuroarthropathy from ePodiatry for health professionals and on Charcot foot for those with diabetes.

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