A Feasibility Study Comparing Usual Foot Education and Phone App Alerts in Patients With Increased Risk of Diabetic Foot

2019 ◽  
Author(s):  
Keyword(s):  
Feasibility Study ◽  
Diabetic Foot ◽  
Increased Risk

scholarly journals Can they stomach it? Parent and practitioner acceptability of a trial comparing gastric residual volume measurement versus no gastric residual volume in UK NNU and PICUs: a feasibility study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Elizabeth Deja ◽  
Louise Roper ◽  
Lyvonne N. Tume ◽  
Jon Dorling ◽  
Chris Gale ◽  
...  
Keyword(s):  
Intensive Care ◽  
Focus Groups ◽  
Feasibility Study ◽  
Research Question ◽  
Tube Feeding ◽  
Careful Consideration ◽  
Paediatric Intensive Care ◽  
Residual Volume ◽  
Gastric Residual Volume ◽  
Increased Risk

Abstract Background Routine measurement of gastric residual volume (GRV) to guide feeding in neonatal and paediatric intensive care is widespread. However, this practice is not evidence based and may cause harm. As part of a feasibility study, we explored parent and practitioner views on the acceptability of a trial comparing GRV measurement or no GRV measurement. Methods A mixed-methods study involving interviews and focus groups with practitioners and interviews with parents with experience of tube feeding in neonatal and/or paediatric intensive care. A voting system recorded closed question responses during practitioner data collection, enabling the collection of quantitative and qualitative data. Data were analysed using thematic analysis and descriptive statistics. Results We interviewed 31 parents and nine practitioners and ran five practitioner focus groups (n=42). Participants described how the research question was logical, and the intervention would not be invasive and potential benefits of not withholding the child’s feeds. However, both groups held concerns about the potential risk of not measuring GRV, including delayed diagnosis of infection and gut problems, increased risk of vomiting into lungs and causing discomfort or pain. Parent’s views on GRV measurement and consent decision making were influenced by their views on the importance of feeding in the ICU, their child’s prognosis and associated comorbidities or complications. Conclusions The majority of parents and practitioners viewed the proposed trial as acceptable. Potential concerns and preferences were identified that will need careful consideration to inform the development of the proposed trial protocol and staff training.

scholarly journals The Guyana Diabetes and Foot Care Project: Improved Diabetic Foot Evaluation Reduces Amputation Rates by Two-Thirds in a Lower Middle Income Country

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Julia Lowe ◽  
R. Gary Sibbald ◽  
Nashwah Y. Taha ◽  
Gerald Lebovic ◽  
Madan Rambaran ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Health Care Professionals ◽  
Phase 1 ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Quality Improvement Intervention ◽  
Foot Care ◽  
Middle Income ◽  
Increased Risk ◽  
Two Phases

Background. Type 2 diabetes is the fourth leading cause of death in Guyana, South America. A complex, interprofessional, quality improvement intervention to improve foot and diabetes care was rolled out in two phases.Methods & Findings. Phase 1: Establishment of an Interprofessional Diabetic Foot Center (DFC) of Excellence to improve foot care and reduce diabetes-related amputations at the national referral hospital. Phase 2: Regionalization to cover 90% of the Guyanese population and expansion to include improved management of diabetes and hypertension. Fourteen key opinion leaders were educated and 340 health care professionals from 97 facilities trained. Eight centers for the evaluation and treatment of foot ulcers were established and 7567 people with diabetes evaluated. 3452 participants had foot screening and 48% were deemed high risk; 10% of these had undocumented foot ulcers. There was a 68% reduction in rate of major amputations (P<0.0001); below knee amputations were decreased by 80%, while above knee amputations were unchanged. An increased association of diabetes with women (F/M = 2.09) and increased risk of major amputation in men [odds ratio 2.16 (95% CI 1.83, 2.56)] were documented.Conclusions. This intervention improved foot care with reduction in major amputations sustained over 5 years.

scholarly journals An iterative design process to develop a randomized feasibility study and inform recruitment of minority women after stillbirth

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Jennifer Huberty ◽  
Jeni Green ◽  
Katherine J. Gold ◽  
Jenn Leiferman ◽  
Joanne Cacciatore
Keyword(s):  
Feasibility Study ◽  
Traumatic Stress ◽  
Emotional Regulation ◽  
Minority Women ◽  
Post Traumatic Stress ◽  
Yoga Intervention ◽  
Iterative Design ◽  
Self Compassion ◽  
Increased Risk ◽  
Post Traumatic

Abstract Background Yearly, approximately 25,000 US women experience stillbirth and African American women have a 2.2 fold increased risk of stillbirth compared with white women. After stillbirth, women are subject to a sevenfold increased risk of post-traumatic stress compared with women after a live-birth. This paper presents findings from phase one of a National Institutes of Health funded, two-phase feasibility study to examine an online yoga intervention to reduce symptoms of post-traumatic stress in mothers after stillbirth. An iterative design was used to (1) inform the development of the online yoga intervention and (2) inform recruitment strategies to enroll minority women into phase two. Methods Ten mothers (N = 5 stillbirth moms with no yoga experience, N = 5 nonstillbirth moms with yoga experience) participated in a series of online yoga videos (N = 30) and were assessed for self-compassion (SC) and emotional regulation (ER) before and after each video. An independent group of five minority women who had experienced stillbirth were interviewed about cultural barriers to recruitment and perceptions/opinions of yoga. A mean was calculated for SC and ER scores for each video at pre- and post-time points. The percent change of the mean difference between pre-post SC and ER scores were used to select videos for phase two. Videos with a negative change score or that had a 0% change on SC or ER were not used. A combination of deductive and inductive coding was used to organize the interview data, generate categories, and develop themes. Results Five of the 30 tested yoga videos were not used. An additional 12 videos were developed, filmed, and used in the prescription for phase two. Topics from interview findings included perceived benefits/barriers of and interest in yoga, preferred yoga environment, suggested recruitment methods, content of recruitment material, and recommended incentives. Conclusions Online yoga may be beneficial for improving emotional regulation and self-compassion, but further testing is needed. Additionally, minority women express interest in online yoga but suggest that researchers apply culturally specific strategies regarding methods, content of material, and incentives to recruit minority women into a study.

scholarly journals Multidisciplinary Approach for the Management and Treatment of Diabetic Foot Infections with a Resorbable, Gentamicin-Loaded Bone Graft Substitute

2020 ◽  
Vol 9 (11) ◽  
pp. 3586
Author(s):  
Christine Whisstock ◽  
Antonio Volpe ◽  
Sasa Ninkovic ◽  
Mariagrazia Marin ◽  
Marco Meloni ◽  
...  
Keyword(s):  
Bone Graft ◽  
Diabetic Foot ◽  
Multidisciplinary Approach ◽  
Calcium Sulphate ◽  
Bone Graft Substitute ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Adequate Treatment ◽  
Diabetic Foot Infections ◽  
Increased Risk

Diabetic patients are at increased risk of developing foot ulcers which may cause bone infections associated with a high probability of both amputation and mortality. Therefore, prompt diagnosis and adequate treatment are of key importance. In our Diabetic Foot Unit, effective multidisciplinary treatment of osteomyelitis secondary to diabetes involves the application of a gentamicin-eluting calcium sulphate/hydroxyapatite bone graft substitute to fill residual bone voids after debridement. The data of all patients treated with the gentamicin-eluting calcium sulphate/hydroxyapatite bone graft substitute for diabetic foot infections with ulcer formation and osteomyelitis at metatarsals, calcaneus and hindfoot at our institute from July 2013 to September 2016 were retrospectively collected and evaluated. A total of 35 patients were included in this retrospective single-arm case series and were either continuously followed up for at least one year or until healing was confirmed. Nineteen lesions affected the distal row of tarsus/talus, ten the calcaneus and a further six were located at the metatarsals. While all of the metatarsal lesions had healed at 1-year follow-up, the healing rate in the hindfoot region was lower with 62.5% at the calcaneus and 72.2% at the distal tarsus and talus at 12 months, respectively. The overall cure rate for ulcerous bone infection was 81.3%. In two calcaneal lesions (25%) and two lesions of distal tarsus/talus (11.1%) amputation was considered clinically necessary. Promising results were achieved in the treatment of diabetic foot infections with soft tissue ulcers by a multidisciplinary approach involving extensive debridement followed by adequate dead space management with a resorbable gentamicin-eluting bone graft substitute.

Risk Factors for Below-the-Knee Amputation in Diabetic Foot Osteomyelitis After Minor Amputation

2019 ◽  
Vol 109 (2) ◽  
pp. 91-97 ◽  
Author(s):  
Whitney Miller ◽  
Chrystal Berg ◽  
Michael L. Wilson ◽  
Susan Heard ◽  
Bryan Knepper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Interquartile Range ◽  
Knee Amputation ◽  
Below The Knee ◽  
Minor Amputation ◽  
Increased Risk ◽  
Transmetatarsal Amputation ◽  
The Impact ◽  
Diabetic Foot Osteomyelitis

Background:Below-the-knee amputation (BKA) can be a detrimental outcome of diabetic foot osteomyelitis (DFO). Ideal treatment of DFO is controversial, but studies suggest minor amputation reduces the risk of BKA. We evaluated risk factors for BKA after minor amputation for DFO.Methods:This is a retrospective cohort of patients discharged from Denver Health Medical Center from February 1, 2012, through December 31, 2014. Patients who underwent minor amputation for diagnosis of DFO were eligible for inclusion. The outcome evaluated was BKA in the 6 months after minor amputation.Results:Of 153 episodes with DFO that met the study criteria, 11 (7%) had BKA. Failure to heal surgical incision at 3 months (P &lt; .001) and transmetatarsal amputation (P = .009) were associated with BKA in the 6 months after minor amputation. Peripheral vascular disease was associated with failure to heal but not with BKA (P = .009). Severe infection, bacteremia, hemoglobin A1c, and positive histopathologic margins of bone and soft tissue were not associated with BKA. The median antibiotic duration was 42 days for positive histopathologic bone resection margin (interquartile range, 32–47 days) and 16 days for negative margin (interquartile range, 8–29 days). Longer duration of antibiotics was not associated with lower risk of BKA.Conclusions:Patients who fail to heal amputation sites in 3 months or who have transmetatarsal amputation are at increased risk for BKA. Future studies should evaluate the impact of aggressive wound care or whether failure to heal is a marker of another variable.

Telemedical home-monitoring of diabetic foot disease using photographic foot imaging – a feasibility study

2011 ◽  
Vol 18 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Constantijn E V B Hazenberg ◽  
Sicco A Bus ◽  
Anke I R Kottink ◽  
Clazien A M Bouwmans ◽  
Anna M Schönbach-Spraul ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Diabetic Foot ◽  
Home Monitoring ◽  
Diabetic Foot Disease ◽  
Foot Disease

scholarly journals A diabeteses láb ischaemiás eredete. Epidemiológia, a diagnózis nehézségei, prevenciós és revascularisatiós lehetőségek

2017 ◽  
Vol 158 (6) ◽  
pp. 203-211 ◽  
Author(s):  
Endre Kolossváry ◽  
Zoltán Bánsághi ◽  
Gábor Viktor Szabó ◽  
Zoltán Járai ◽  
Katalin Farkas
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Diagnostic Tools ◽  
Public Health Issue ◽  
Effective Prevention ◽  
Increased Risk ◽  
Peripheral Arterial

Abstract: “Diabetic foot” as definition covers a multifactorial clinical condition. According to the recent epidemiological data, the role of lower limb ischemia is getting more influential over other pathological causes, like neuropathy, infections and bone or soft tissue deformity. In diabetes, vascular disease leads to increased risk for leg ulcers and minor or major amputations. The traditional diagnostic tools for recognition of peripheral arterial disease have limited value because of diabetes specific clinical manifestations. Available vascular centers with special expertise and diagnostic tools are the prerequisite for efficient diagnosis supporting timely recognition of peripheral arterial disease. In course of treatment of diabetic foot with ischemic origin, beyond effective medical treatment revascularization (open vascular surgery or endovascular procedures) has paramount importance for prevention of limb loss. Vascular teams of vascular specialists, vascular surgeons and interventional radiologist in dedicated centers in multidisciplinary cooperation with other professions represent public health issue in effective prevention. Orv. Hetil., 2017, 158(6), 203–211.

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