Return home after dysvascular major amputation of the lower limb: A multicentre observational study in the Netherlands

Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to local prescription variations with regard to overuse or underuse of prosthetic care and a lack of transparency for consumers and health insurance companies. Hence a clinical guideline may lead to a more consistent and efficient clinical practice and thus more uniformly high quality care. The purpose of this study was to get insight into potential similarities in prescription criteria in clinical practice in the Netherlands. Secondly, the authors were interested to know if prosthetic prescription was primarily based on the level of activity or intended use of the prosthesis. As part of the development of a consensus-based clinical guideline a multi-centred, cross-sectional study was carried out in order to observe the prosthetic prescription for a group of lower limb amputees. Therefore prescription data were collected from 151 amputees with trans-femoral amputation, knee disarticulation or trans-tibial amputation. Results of the multiple logistic regression show no relationship between the activity level and any of the variables included in the equation such as the hospital or medical doctor in Physical and Rehabilitation Medicine (MD in P&RM), prosthetic components, age of the amputee or reason of amputation. The criteria used are merely based on the clinical expertise and local experience whereas the actual prescriptions differ from location to location. In conclusion the development of a clinical guideline for prosthetic prescription in lower limb amputation is recommended. The information gained from this observational study will be used in a clinical guideline procedure for prosthetic prescription in the Netherlands.

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Faculty Opinions recommendation of The incidence of low venous oxygen saturation on admission to the intensive care unit: a multi-center observational study in The Netherlands.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1131846.588934 ◽

2008 ◽

Author(s):

Martin Duenser

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

The Netherlands ◽

Observational Study ◽

Oxygen Saturation ◽

Venous Oxygen Saturation

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Study on Pramana Shareera in relation to Prakriti

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v2i3.8211 ◽

2016 ◽

Vol 2 (3) ◽

Author(s):

Rajendra Pai N. ◽

U. Govindaraju

Keyword(s):

Observational Study ◽

Upper Limb ◽

Lower Limb ◽

Characteristic Property ◽

The Body ◽

Artificial Limbs ◽

Body Parts ◽

Unit Of Measurement ◽

The Individual ◽

Different Parts

Ayurveda in its principle has given importance to individualistic approach rather than generalize. Application of this examination can be clearly seem like even though two patients suffering from same disease, the treatment modality may change depending upon the results of Dashvidha Pariksha. Prakruti and Pramana both used in Dashvidha Pariksha. Both determine the health of the individual and Bala (strength) of Rogi (Patient). Ayurveda followed Swa-angula Pramana as the unit of measurement for measuring the different parts of the body which is prime step assessing patient before treatment. Sushruta and Charaka had stated different Angula Pramana of each Pratyanga (body parts). Specificity is the characteristic property of Swa-angula Pramana. This can be applicable in present era for example artificial limbs. A scientific research includes collection, compilation, analysis and lastly scrutiny of entire findings to arrive at a conclusion. Study of Pramana and its relation with Prakruti was conducted in 1000 volunteers using Prakruti Parkishan proforma with an objective of evaluation of Anguli Pramana in various Prakriti. It was observed co-relating Pramana in each Prakruti and Granthokta Pramana that there is no vast difference in measurement of head, upper limb and lower limb. The observational study shows closer relation of features with classical texts.

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Safety aspect of intraoperative, local urokinase lysis in patients with acute lower limb ischemia

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-201049 ◽

2021 ◽

pp. 1-10

Author(s):

Schierling Wilma ◽

Bachleitner Kathrin ◽

Kasprzak Piotr ◽

Betz Thomas ◽

Stehr Alexander ◽

...

Keyword(s):

Major Bleeding ◽

Lower Limb ◽

Limb Ischemia ◽

Major Amputation ◽

Artery Occlusion ◽

Outflow Tract ◽

Intracranial Bleeding ◽

Minor Bleeding ◽

Free Survival ◽

Lower Limb Ischemia

BACKGROUND: Acute lower limb ischemia (ALI) is associated with a high risk of limb loss and death. OBJECTIVE: The present study evaluates the safety of intraoperative, local urokinase lysis in patients with ALI and crural artery occlusion. METHODS: A total of 107 patients (115 legs) were treated surgically for ALI with additional intraoperative urokinase lysis to improve the outflow tract. Minor and major bleeding as well as efficacy of treatment and amputation-free survival were investigated. RESULTS: Complete restoration of at least one run-off vessel was achieved in 64%. Collateralization was improved in 34%. Lysis failed in 2%. Major amputation rate was 27%overall (12%within 30 days) and depended on Rutherford class of ALI (overall/30 day: IIa 11%/6%; IIb 20%/17%; III 37%/15%). Amputation-free survival turned out to be 82%after 30 days, 58%after one, and 41%after five years. Minor bleeding occurred in 21%(24/115) and major bleeding in 3.5%(4/115). One of these patients died of haemorrhage. No patient experienced intracranial bleeding. CONCLUSION: Intraoperative urokinase lysis improves limb perfusion and causes low major and intracranial bleeding. It can be safely applied to patients with severe ischaemia when surgical restoration of the outflow tract fails.

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Factors that affect the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/22104917211056949 ◽

2021 ◽

Vol 28 ◽

pp. 221049172110569

Author(s):

Pui M Chung ◽

Bolton KH Chau ◽

Esther C-S Chow ◽

Kwok H Lam ◽

Nang MR Wong

Keyword(s):

Mortality Rate ◽

Lower Limb ◽

Chinese Population ◽

Major Amputation ◽

Lower Limb Amputation ◽

Hong Kong Chinese ◽

Limb Amputation ◽

The Mean ◽

One Year ◽

The One

Introduction Lower limb amputation has significant morbidity and mortality. This study reviews the potential factors affecting the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population. Methods Cases with lower limb amputations (toe, ray, below-knee, and above-knee amputations) from a regional hospital from January 2016 to December 2017 were recruited. Amputations due to trauma were excluded. The one-year mortality rate and the potential risk factors (age, sex, length-of-stay, multiple operations, extent of surgery (minor vs. major), medical comorbidities including (1) end-stage renal failure (ESRF), (2) cardiac diseases, (3) ischemic heart disease, (4) peripheral vascular disease and (5) diabetes mellitus) were analyzed by multiple logistic regression using Matlab 2018a. Results A total of 132 patients were recruited (173 operations). The one-year mortality rate was 36.3%. The mean age at death was 72.2 years. The results of the regression analysis showed patients having ESRF (β = 2.195, t 120 = 3.008, p = 0.003) or a major amputation (including above- or below-knee amputation) (β = 1.079, t 120 = 2.120, p = 0.034), had a significantly higher one-year mortality. The remaining factors showed no significant effect. The one-year mortality rate in ESRF patients was 77.8%; while the one-year mortality rate without ESRF was 29.8%. The mean age at death in the ESRF group was 62.9 years; while that without ESRF was 76.1 years. The one-year mortality for patients with major amputation was 45.8% while that for minor amputation was 20.4%. Conclusion ESRF and major amputation are factors that increase the one-year mortality rate after lower limb amputation.

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Dietary taste patterns by sex and weight status in the Netherlands

British Journal Of Nutrition ◽

10.1017/s0007114518000715 ◽

2018 ◽

Vol 119 (10) ◽

pp. 1195-1206 ◽

Cited By ~ 10

Author(s):

Astrid W. B. van Langeveld ◽

Pey Sze Teo ◽

Jeanne H. M. de Vries ◽

Edith J. M. Feskens ◽

Cees de Graaf ◽

...

Keyword(s):

The Netherlands ◽

Observational Study ◽

Food Choice ◽

Weight Status ◽

Normal Weight ◽

Taste Preferences ◽

Food Consumption Survey ◽

Key Driver ◽

Consumption Survey

AbstractTaste is a key driver of food choice and intake. Taste preferences are widely studied, unlike the diet’s taste profile. This study assessed dietary taste patterns in the Netherlands by sex, BMI, age and education. A taste database, containing 476 foods’ taste values, was combined with 2-d 24-h recalls in two study populations. The percentage of energy intake from six taste clusters was assessed in the Dutch National Food Consumption Survey (DNFCS 2007–2010; n 1351) and in an independent observational study: the Nutrition Questionnaires plus (NQplus) study (2011–2013; n 944). Dietary taste patterns were similar across study populations. Men consumed relatively more energy from ‘salt, umami and fat’ (DNFCS; 24 % energy, NQplus study; 23 %)- and ‘bitter’ (7 %)-tasting foods compared with women (21 %, P<0·001, 22 %, P=0·005; 3 %, P<0·001, 4 %, P<0·001, respectively). Women consumed more % energy from ‘sweet and fat’ (15 %)- and ‘sweet and sour’ (13 %, 12 %, respectively)-tasting foods compared with men (12 %, P<0·001, 13 %, P=0·001; 10 %, P<0·001). Obese individuals consumed more % energy from ‘salt, umami and fat’- and less from ‘sweet and fat’-tasting foods than normal-weight individuals (‘salt, umami and fat’, men; obese both studies 26 %, normal-weight DNFCS 23 %, P=0·037, NQplus 22 %, P=0·001, women; obese 23 %, 24 %, normal weight 20 %, P=0·004, P=0·011, respectively, ‘sweet and fat’, men; obese 11 %, 10 %, normal weight 13 %, P<0·05, 14 %, P<0·01, women; obese 14 %, 15 %, normal weight 16 %, P=0·12, P=0·99). In conclusion, our taste database can be used to deepen our understanding of the role of taste in dietary intake in the Netherlands by sex, BMI, age and education.

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Lower Limb Amputation Rates in Patients With Diabetes and an Infected Foot Ulcer: A Prospective Observational Study

Wound Management & Prevention ◽

10.25270/wmp.2021.7.2230 ◽

2021 ◽

Vol 67 (7) ◽

pp. 22-30

Author(s):

Natasha Chaudhary ◽

Farhanul Huda ◽

Ravi Roshan ◽

Somprakas Basu ◽

Deepak Rajput ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Clinical Signs ◽

Foot Ulcer ◽

Arterial Disease ◽

Major Amputation ◽

Lower Extremity Amputation ◽

Patients With Diabetes ◽

Peripheral Arterial ◽

Extremity Amputation

BACKGROUND: Lower extremity amputation is a serious complication of diabetes mellitus and occurs most commonly in persons who have a foot ulcer. PURPOSE: To examine variables that affect the rate of lower extremity amputation in patients with diabetes and infected foot ulcers. METHODS: A prospective observational study was performed including all consecutive patients who were 18 to 65 years, had a diagnosis of diabetes, and a foot ulcer showing clinical signs of infection. Patients were followed for 6 months or until ulcer healing, minor, or major amputation. A total of 81 persons were enrolled. Demographic variables were obtained, and clinical assessments, blood tests, and radiological investigations were performed. Ulcers were categorized using the Perfusion, Extent, Depth, Infection and Sensation classification system. Differences between variables and outcomes were assessed using the Wilcoxon test, Fisher’s exact test, Chi-square test, and t-test. RESULTS: Mean patient age was 54.58 ± 9.04 years, and the majority (61, 75%) were male. After 6 months, 33 (41%) were healed, 2 patients died, and 17 (21%) underwent major and 24 (30%) minor amputations. Major amputation rates were significantly higher in patients with a high Perfusion, Extent, Depth, Infection and Sensation score (6.92 ± 1.36; P = .005), elevated HbA1c (%) (9.43 ± 2.19; P = .049), presence of growth on wound culture (41 [64.1%]; P = .016), culture sensitivity to beta lactam (20 [31.2%]; P = .012), and presence of peripheral arterial disease seen on arterial Doppler ultrasound (P < .001). Minor amputation rates were higher in men (P = .02) and in the presence of peripheral arterial disease (P = .01). CONCLUSION: The presence of the above factors in persons with diabetes and foot ulcer with clinical signs of infection should alert the clinician to the need for focused and individualized treatment to attempt to prevent amputation.

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