Standardising practices improves clinical diabetic foot management: the Queensland Diabetic Foot Innovation Project, 2006 - 09

2012 ◽  
Vol 36 (1) ◽  
pp. 8 ◽  
Author(s):  
Peter A. Lazzarini ◽  
Sharon R. O'Rourke ◽  
Anthony W. Russell ◽  
Patrick H. Derhy ◽  
Maarten C. Kamp
Keyword(s):  
Diabetic Foot ◽  
Clinical Management ◽  
Clinical Training ◽  
Clinical Pathways ◽  
The Body ◽  
Data Availability ◽  
Clinical Activity ◽  
Multidisciplinary Teams ◽  
High Risk Population ◽  
Foot Complications

Objective. The aim of this paper is to report the clinical practice changes resulting from strategies to standardise diabetic foot clinical management in three diverse ambulatory service sites in Queensland, Australia. Methods. Multifaceted strategies were implemented in 2008, including: multidisciplinary teams, clinical pathways, clinical training, clinical indicators, and telehealth support. Prior to the intervention, none of the aforementioned strategies were used, except one site had a basic multidisciplinary team. A retrospective audit of consecutive patient records from July 2006 to June 2007 determined baseline clinical activity (n = 101). A clinical pathway teleform was implemented as a clinical activity analyser in 2008 (n = 327) and followed up in 2009 (n = 406). Pre- and post-implementation data were analysed using Chi-square tests with a significance level set at P < 0.05. Results. There was an improvement in surveillance of the high risk population of 34% in 2008 and 19% in 2009, and treating according to risk of 15% in 2009 (P < 0.05). The documentation of all best-practice clinical activities performed improved 13–66% (P < 0.03). Conclusion. These findings support the use of multifaceted strategies to standardise practice and improve diabetic foot complications management in diverse ambulatory services. What is known about the topic? Diabetic foot complications are recognised as the most common reason for diabetes-related hospitalisation and lower extremity amputations. Approximately 20% of people with diabetes in Australia are at risk of developing a diabetic foot ulcer. Multifaceted strategies to reduce diabetic foot hospitalisation and amputation rates have been successful. However, most people with diabetic foot ulcers are managed in ambulatory settings where data availability is poor and studies limited. What does this paper add? This paper demonstrates that significant improvements in evidence-based diabetic foot complication management can be achieved in diverse Australian ambulatory care settings with multifaceted strategies. This paper contributes to the body of knowledge regarding diabetic foot clinical management in ambulatory settings. What are the implications for practitioners? Practical strategies are available to improve clinical management across a variety of ambulatory settings. Substantial literature suggests this should translate to reduced rates of hospitalisation and amputation for diabetic foot complications.

scholarly journals Unilateral remote temperature monitoring to predict future ulceration for the diabetic foot in remission

2019 ◽  
Vol 7 (1) ◽  
pp. e000696 ◽  
Author(s):  
Lawrence A Lavery ◽  
Brian J Petersen ◽  
David R Linders ◽  
Jonathan D Bloom ◽  
Gary M Rothenberg ◽  
...  
Keyword(s):  
High Risk ◽  
Diabetic Foot ◽  
Lead Time ◽  
Predictive Accuracy ◽  
Characteristic Curve ◽  
Temperature Monitoring ◽  
Threshold Temperature ◽  
High Risk Population ◽  
Foot Complications ◽  
Sensitivity Specificity

ObjectiveDaily remote foot temperature monitoring is an evidence-based preventive practice for patients at risk for diabetic foot complications. Unfortunately, the conventional approach requires comparison of temperatures between contralaterally matched anatomy, limiting practice in high-risk cohorts such as patients with a wound to one foot and those with proximal lower extremity amputation (LEA). We developed and assessed a novel approach for monitoring of a single foot for the prevention and early detection of diabetic foot complications. The purpose of this study was to assess the sensitivity, specificity, and lead time associated with unilateral diabetic foot temperature monitoring.Research design and methodsWe used comparisons among ipsilateral foot temperatures and between foot temperatures and ambient temperature as a marker of inflammation. We analyzed data collected from a 129-participant longitudinal study to evaluate the predictive accuracy of our approach. To evaluate classification accuracy, we constructed a receiver operator characteristic curve and reported sensitivity, specificity, and lead time for four different monitoring settings.ResultsUsing this approach, monitoring a single foot was found to predict 91% of impending non-acute plantar foot ulcers on average 41 days before clinical presentation with a resultant mean 4.2 alerts per participant-year. By adjusting the threshold temperature setting, the specificity could be increased to 78% with corresponding reduced sensitivity of 53%, lead time of 33 days, and 2.2 alerts per participant-year.ConclusionsGiven the high incidence of subsequent diabetic foot complications to the sound foot in patients with a history of proximal LEA and patients being treated for a wound, practice of daily temperature monitoring of a single foot has the potential to significantly improve outcomes and reduce resource utilization in this challenging high-risk population.

Nationwide prevalence and clinical characteristics of inpatient diabetic foot complications: A Peruvian multicenter study

2021 ◽  
Author(s):  
Marlon Yovera-Aldana ◽  
Sofia Sáenz-Bustamante ◽  
Yudith Quispe-Landeo ◽  
Rosa Agüero-Zamora ◽  
Julia Salcedo ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Diabetic Foot ◽  
Clinical Characteristics ◽  
Foot Complications

scholarly journals Joint Consultation Clinic by Infectious Diseases Specialists and Podiatry team (ID-POD) Compliments the Care of Diabetic Patients with Foot Infections by Reducing Cost and Decreasing Outpatient Clinic Visits

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S328-S328
Author(s):  
Pushpalatha Bangalore Lingegowda ◽  
Say-Tat Ooi ◽  
Jyoti Somani ◽  
Chelsea Law ◽  
Boon Kiak Yeo
Keyword(s):  
Infectious Diseases ◽  
Diabetic Foot ◽  
Wound Care ◽  
Cost Savings ◽  
Outpatient Setting ◽  
Multidisciplinary Teams ◽  
Diabetic Patients ◽  
Wound Debridement ◽  
Diabetic Foot Infections ◽  
Before And After

Abstract Background Management of diabetic foot infections (DFI) is challenging and involves multidisciplinary teams to improve outcomes (1). Appropriate wound care of patients with DFI plays an important role in successfully curing infections and promote wound healing. In Singapore, Infectious Diseases (ID) specialists help in the management of DFI by recommending appropriate antibiotics for infected wounds while wound debridement are managed by Podiatrists (POD). When patients are hospitalized multidisciplinary teams including Vascular Surgery review patients. In the outpatient setting patients have multiple appointments including ID and Endocrinology etc. The time spent and costs incurred by patients for traveling to multiple appointments is considerable. A joint ID-POD clinic was initiated to reduce the cost and inconvenience for patients. Methods A joint weekly clinic was initiated in October’16 and the data was analyzed upto May’17. Finance was involved in deriving costs. The service costs for consultations payable by patients before and after the initiation of the joint clinic were compared. Results First 6 months experience of initiating the joint ID-POD clinic is reported. 35 unique patients had a total of 88 visits. 1/third of the patients had more than 2 visits to the joint clinic. For each visit to the joint clinic the patient paid 25% less compared with having separate clinics. The hospital lowered the service cost for the new clinic by 11%. This was done by minimizing the time involvement of the ID physician. Conclusion Joint ID-POD clinic for managing diabetic patients with foot infections revealed several advantages. Hospital outpatient visits for each patient decreased by 50% for those requiring care of both ID and POD, without compromising care. With the consolidation of care each individual patient had a cost savings of 25% for the joint consultation. This joint clinic while making it convenient for patients has revealed significant cost savings to patients especially for those requiring multiple visits. We recommend hospitals with high prevalence of Diabetes and Diabetic foot infections to consider joint ID-POD clinics to reduce hassle and increase saving for patients. Disclosures All authors: No reported disclosures.

scholarly journals P02.49: Prenatal diagnosis and clinical management of the body stalk anomaly during gestation. The importance of the precocious diagnostic

2006 ◽  
Vol 28 (4) ◽  
pp. 534-534
Author(s):  
E. Cordioli ◽  
L. C. S. Bussamra ◽  
G. Lobo ◽  
C. A. Souza ◽  
W. J. Hisaba ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Clinical Management ◽  
The Body

scholarly journals Infrared Thermal Imaging for Automated Detection of Diabetic Foot Complications

2013 ◽  
Vol 7 (5) ◽  
pp. 1122-1129 ◽  
Author(s):  
Jaap J. van Netten ◽  
Jeff G. van Baal ◽  
Chanjuan Liu ◽  
Ferdi van der Heijden ◽  
Sicco A. Bus
Keyword(s):  
Diabetic Foot ◽  
Thermal Imaging ◽  
Automated Detection ◽  
Infrared Thermal Imaging ◽  
Foot Complications

scholarly journals STANDARDIZED CLINICAL PATHWAYS FOR ESOPHAGECTOMY ARE NOT A REALITY IN BRAZIL, EVEN WITH A HIGH PREVALENCE OF ESOPHAGEAL CANCER AND ACHALASIA

2015 ◽  
Vol 28 (3) ◽  
pp. 190-192 ◽  
Author(s):  
Marina ZAMUNER ◽  
Fernando A. M. HERBELLA ◽  
José L. B. AQUINO
Keyword(s):  
Clinical Pathways ◽  
Early Mobilization ◽  
Sao Paulo ◽  
Work Team ◽  
Multidisciplinary Teams ◽  
São Paulo ◽  
Clinical Practices ◽  
Paulo State ◽  
High Prevalence ◽  
São Paulo State

Background: The adoption of standardized protocols and specialized multidisciplinary teams for esophagectomy involve changes in routines with the implantation of expensive clinical practices and deviations from ingrained treatment philosophies. Aim: To evaluate the prevalence of standardized protocols and specialized multidisciplinary teams in São Paulo state, Brazil. Methods: Institutions that routinely perform esophagectomies in São Paulo were contacted and questioned about the work team involved in the procedure and the presence of standardized routines in the preoperatory care. Results: Fifteen centers answered the questionnaire: 10 (67%) public institutions and five (33%) private. There were seven (47%) medical schools, six (40%) with a residency program and two (13%) nonacademic institutions. The mean number of esophagectomies per year was 23. There was a multidisciplinary pre-operative team in nine (60%). There was a multidisciplinary postoperative team in 11 (73%). Early mobilization protocol was adopted in 12 (80%) institutions, early feeding in 13 (87%), routinely epidural in seven (47%), analgesia protocol in seven (47%), hydric restriction in six (40%), early extubation in six (40%), standardized hospitalization time in four (27%) and standardized intensive care time in two (13%). Conclusion: The prevalence of standardized protocols and specialized teams is very low in Sao Paulo state, Brazil. The presence of specialized surgeons is a reality and standardized protocols related directly to surgeons have higher frequency than those related to other professionals in the multidisciplinary team.

scholarly journals Characteristics Predicting the Outcome in Individuals with Diabetic Foot Ulcerations

2017 ◽  
Vol 107 (3) ◽  
pp. 180-191 ◽  
Author(s):  
Lourdes Vella ◽  
Cynthia Formosa
Keyword(s):  
Ulcer Healing ◽  
Diabetic Foot ◽  
Health Care Professionals ◽  
Hemoglobin A1c ◽  
Foot Ulcer ◽  
Patient Characteristics ◽  
Outpatient Setting ◽  
Foot Complications

Background: We sought to determine patient and ulcer characteristics that predict wound healing in patients living with diabetes. Methods: A prospective observational study was conducted on 99 patients presenting with diabetic foot ulceration. Patient and ulcer characteristics were recorded. Patients were followed up for a maximum of 1 year. Results: After 1 year of follow-up, ulcer characteristics were more predictive of ulcer healing than were patient characteristics. Seventy-seven percent of ulcers had healed and 23% had not healed. Independent predictors of nonhealing were ulcer stage (P = .003), presence of biofilm (P = .020), and ulcer depth (P = .028). Although this study demonstrated that the baseline hemoglobin A1c reading at the start of the study was not a significant predictor of foot ulcer outcome (P = .603, resolved versus amputated), on further statistical analyses, when hemoglobin A1c was compared with the time taken for complete ulcer healing (n = 77), it proved to be significant (P = .009). Conclusions: The factors influencing healing are ulcer stage, presence of biofilm, and ulcer depth. These findings have important implications for clinical practice, especially in an outpatient setting. Prediction of outcome may be helpful for health-care professionals in individualizing and optimizing clinical assessment and management of patients. Identification of determinants of outcome could result in improved health outcomes, improved quality of life, and fewer diabetes-related foot complications.

scholarly journals Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

2021 ◽  
Author(s):  
Edward J. Boyko
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Past History ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Information ◽  
Arterial Perfusion ◽  
Primary Care Population ◽  
Foot Complications ◽  
Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

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