scholarly journals Will Multidisciplinary Collaboration Reduce the Disability Rate of Diabetic Foot (2009–2019)?—A Study Based on the Perspective of Organizational Reform

2021 ◽  
Vol 9 ◽  
Author(s):  
Mengchi Hou ◽  
Xue Gong ◽  
Wenhu Chang ◽  
Jie Dong ◽  
Feifei Zhao ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Average Length ◽  
Three Dimensions ◽  
Final Conclusion ◽  
Inpatient Service ◽  
Medical Procedure ◽  
Disability Score ◽  
Multidisciplinary Collaboration ◽  
Organizational Reform ◽  
One Stop

Objectives: Discuss the experience and practice of multidisciplinary cooperation of diabetic foot in China and analyze its impact on the quality of care.Methods: This study observed the medical procedure by interviewing 12 key personnel in-depth. We extracted data from medical records and assessed the effect of MDT in three dimensions: quality, efficiency, and cost, to eventually achieve a final conclusion.Results: The studied reform includes the following three aspects: the adjustment of hospital buildings layout and disciplines, one-stop outpatient, and one-stop inpatient service. After the multidisciplinary collaboration, the rate of above-knee amputation is reduced by 3.63%, the disability score per 100 diabetic foot patients decreases by 6.12, the average length of stay decreases significantly, and the cost of hospitalization shows an increasing trend.Conclusions: Multidisciplinary collaboration is performed based on spatial layout adjustment and clinical pathway optimization, which provide more comprehensive and integrated care than a general medical team or a single specialist, thereby reducing the rate of disability, shortening the length of hospitalization. Besides, the new measurable indicator called disability score per 100 diabetic foot patients has been verified to evaluate the living ability of patients after surgery. This paper provides a reference for organizational reform of multidisciplinary diseases to support treatment and management of other multiorgan diseases.

Evaluation and treatment of the infected foot in a community teaching hospital

1996 ◽  
Vol 86 (9) ◽  
pp. 421-426 ◽  
Author(s):  
WF Todd ◽  
DG Armstrong ◽  
PJ Liswood
Keyword(s):  
Diabetic Foot ◽  
Average Length ◽  
Treatment Protocol ◽  
Cost Effective ◽  
Primary Diagnosis ◽  
Care Team ◽  
Team Approach ◽  
Foot Care ◽  
Hospital Days ◽  
Community Teaching

More inpatient hospital days are used for the care of diabetic foot infection than for any other diabetic sequela. Both the number of lower extremity amputations and the overall treatment cost of treating diabetic infections may be reduced by using a team approach in the care of the infected diabetic pedal wound. The authors propose an evaluation and treatment protocol of infected pedal ulcerations in an urban, community teaching institution when admitted to an established, multidisciplinary diabetic foot care team. The hospital course of 111 patients admitted with a primary diagnosis of infected pedal ulceration are retrospectively reviewed. Results revealed an average-length hospital stay of 7.4 days with a 96% limb-salvage rate. The authors suggest that in the treatment of the infected pedal wound, a diabetic foot care team with a well developed treatment protocol may yield a consistently favorable outcome and a cost-effective hospital course.

scholarly journals Videocapillaroscopy of the Oral Mucosa in Patients with Diabetic Foot: Possible Diagnostic Role of Microangiopathic Damage?

2020 ◽  
Vol 9 (11) ◽  
pp. 3641
Author(s):  
Giuseppe A. Scardina ◽  
Giovanni Guercio ◽  
Cesare F. Valenti ◽  
Domenico Tegolo ◽  
Pietro Messina
Keyword(s):  
Clinical Diagnosis ◽  
Oral Mucosa ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Average Length ◽  
T Test ◽  
Control Group ◽  
Anova Test ◽  
Diagnostic Role

Introduction: Diabetic foot represents one of the most serious and expensive complications of diabetes and is subject to a high percentage of amputations that are almost always preceded by ulcers ascribable to neuropathy and/or vasculopathy. Videocapillaroscopy (VCS) can be a valuable aid in order to uncover morpho-structural anomalies in the vascular bed, both at the level of the oral mucosa and at the level of the terminal vessels of the lower limb. Materials and methods: Sixty subjects divided into 4 groups were enrolled: 15 healthy subjects; 15 patients with diabetes for more than 10 years without ulcerative foot lesions; 15 patients with neuropathic diabetic foot (clinical diagnosis, MDNS); 15 patients with ischemic diabetic foot (clinical diagnosis, ABI, lower limb doppler). A complete videocapillaroscopic mapping of the oral mucosa was carried out on each patient. The areas investigated were: labial mucosa, the retro-commissural region of the buccal mucosa, and the vestibular masticatory mucosa (II and V sextant). Results: The analysis of the morphological and densitometric characteristics of the capillaries revealed the following: a significant reduction in capillary density in neuropathic (mean ± SD 7.32 ± 2.1) and ischemic patients (mean ± SD 4.32 ± 3.2) compared to the control group of patients (both diabetic mean ± SD 12.98 ± 3.1 and healthy mean ± SD 19.04 ± 3.16) (ANOVA test and Bonferroni t test p < 0.05); a reduction in the average length of the capillaries and a significant increase in tortuosity (ANOVA test and Bonferroni t test p < 0.05). In the neuropathic patients, a recurrent capillaroscopic pattern that we defined as “sun” was found, with capillaries arranged radially around an avascular area. Conclusions: The data obtained from this preliminary study suggest a potential diagnostic role of oral capillaroscopy in the early and subclinical identification of microangiopathic damage in patients with diabetic foot.

scholarly journals Comparison of three antimicrobial strategies in diabetic foot infections post-amputation

2019 ◽  
Vol 6 ◽  
pp. 204993611986454
Author(s):  
Samarth P. Shah ◽  
Ana Negrete ◽  
Timothy Self ◽  
Jaclyn Bergeron ◽  
Jennifer D. Twilla
Keyword(s):  
Patient Outcomes ◽  
Diabetic Foot ◽  
Hospital Admissions ◽  
Average Length ◽  
Primary Diagnosis ◽  
Antimicrobial Treatment ◽  
Optimal Route ◽  
Average Length Of Stay ◽  
Diabetic Foot Infections ◽  
Selection Of

Background: The 2012 Infectious Disease Society of America (IDSA) guidelines recommend antimicrobial treatment of diabetic foot infections (DFIs) post-amputation, but the optimal route and duration are poorly defined. Objective: The objective of this study was to determine whether the selection of a specific antimicrobial treatment modality affected hospital and patient outcomes. Methods: This was a retrospective review of hospital admissions of adults admitted to ourhealthcare system with a primary diagnosis of DFIs post-amputation. The groups were separated into patients who received intravenous antimicrobials (IV), oral antimicrobials (PO), or no antimicrobials (NA). Outcomes included average length of stay among others. Results: Of the 200 patients screened, 120 patients were included (IV n = 72; PO n = 20; NA n = 28). No statistically significant differences were identified in average LOS (IV = 9.97 ± 5.85, PO = 8.83 ± 7.37, NA = 9.33 ± 5.91 days; p = 0.73). However, post-operative (post-op) LOS was significantly shorter in the PO group (PO = 3.43 ± 2.56, IV = 7.34 ± 5.95, NA = 5.81 ± 4.18 days; p = 0.0001). Conclusion: The results of our study indicate that a PO antimicrobial treatment strategy post amputation for DFIs has the potential to decrease post-op LOS without increasing the risk of readmission. Based on the results of our study, we feel consideration should be given to transition to oral antimicrobials soon after amputation to facilitate discharge and decrease the utilization of intravenous antimicrobials.

Multidisciplinary team management for high grade immune-related adverse events (irAEs): A single center experience.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e15076-e15076
Author(s):  
PRABHSIMRANJOT SINGH ◽  
Osama Abu-Shawer ◽  
Amanda Brito ◽  
Eric Yenulevich ◽  
Shilpa Grover ◽  
...  
Keyword(s):  
Adverse Events ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Massachusetts General Hospital ◽  
Average Length ◽  
Immunosuppressive Agents ◽  
Future Research ◽  
Inpatient Service ◽  
High Grade

e15076 Background: Immune checkpoint inhibitors (ICIs) are increasingly used in the management of cancer. High grade irAEs are uncommon but can be severe and require hospital admission. There is an urgent need for early identification and triage of patients with irAEs in order to improve their management and outcomes. Methods: We established Immunotherapy toxicity (ITOX) team as the first in nation inpatient service at DFCI and Brigham and Women's Hospital (BWH) along with our partners at Massachusetts General Hospital (MGH) that is specifically devoted to mitigating irAEs. The ITOX service is consistent of 2 PAs and a medical oncology attending with an expertise in immunotherapy. The service utilizes algorithms that are modified from the ASCO and NCCN guidelines by our medical subspecialty experts at BWH. The service uses a multi-disciplinary approach with around the hour consulting service from experts in the field including GI, pulmonary, endocrinology and others. We leveraged EPIC to triage patients who are admitted to BWH and have ever received or currently on immune checkpoint inhibitors (ICIs). The daily list generated by EPIC is then curated manually by a PA to identify patients with potential irAEs. Results: A total of 138 patients with high grade irAEs were admitted to BWH between June 2018 and June 2019. Seventy percent of the 201 irAEs- related admissions were to ITOX service (70% accuracy in triaging). Most common irAEs was colitis (31%), pneumonitis (28%) and hepatitis (13%) which is consistent with the most common reported irAEs due to ICIs. Eighty five percent of the patients had grade 3 irAEs and 15% were admitted with life threatening grade 4 adverse events. About half of the patient had received ICI monotherapy; 33% received combination of ICI and non-ICI (chemotherapy or targeted therapy) and 17% received combination of ICIs. Most patients responded to steroids and only 9% had steroid-refractory irAEs requiring other immunosuppressive agents. The average length of stay for irAEs-related admission was 11 days with readmission rate of 26% within a year. Over 50 patients consented for tissue and blood biospecimen collection at the time of toxicity. Conclusions: We demonstrated the feasibility of empowering EMR to accurately triage patients with suspected irAEs to the ITOX service that is supported by institution developed guidelines and specialists. Our model is adaptable in major academic centers and can have major impact on quality improvement and future research studies that can be conducted in this unique setting.

scholarly journals Factors influencing length of hospital stay in patients with diabetic foot ulcers

2021 ◽  
Vol 16 (2) ◽  
pp. 234-240
Author(s):  
George NIȚĂ ◽  
◽  
Andreea GHERASIM ◽  
Otilia NIȚĂ ◽  
Alina Delia POPA ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Diabetic Foot ◽  
Blood Cells ◽  
Average Length ◽  
White Blood Cells ◽  
Length Of Hospital Stay ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Biological Parameters ◽  
Total Proteins

Diabetic foot represents the consequence of changes caused by diabetes in the foot, meaning an association of infection, ulceration and / or destruction of deep tissues with neuropathy and peripheral vascular disease in the foot, below the ankle. The aim of the study was to evaluate the factors that may influence the length of hospital stay in patients with diabetic foot ulcers. Material and methods. An observational study was performed on a sample of patients hospitalized in the Diabetes, Nutrition and Metabolic Diseases Clinic within "St. Spiridon” County Emergency Clinical Hospital, Iași, between 01.01.2007 and 31.12.2017. Sociodemographic characteristics of the patients, history of the disease, biological parameters, duration of hospitalization were registered in a database. Severity of foot ulcerations was quantified using the San Elian Wound Scoring System (SEWSS). The relationships between length of hospital stay, severity of ulceration, biological parameters and complications of diabetes were analyzed. Results. The average length of hospital stay in the studied group was 19.68 ± 13.38 days. When analyzing the correlation between length of hospital stay and inflammatory parameters, we found that it correlated positively with white blood cells, neutrophils (PMN), C-reactive protein (CRP) and negatively with hemoglobin, hematocrit, total proteins, alkaline reserve and sideremia. Assessment of the severity of ulcerations using SEWSS (mild, moderate and severe) revealed a percentage of 85.7% of cases with moderate grade ulcers, and 9% of cases having severe grade ulcers. Severity of ulcerations correlated inversely with hemoglobin, hematocrit, total proteins and sideremia. Direct correlations were found between the severity score and the following parameters: white blood cells, PMN, fibrinogen, CRP. The length of hospital stay was significantly correlated with the severity of ulceration assessed by the SEWSS (r = 0.272, p < 0.001). Conclusions. Admission in the hospital with more severe ulcerations has been associated with increased length of hospital stay, thus suggesting the need for patient education and active screening of the diabetic foot.

Identifying Factors of Integration for an Interoperable Government Portal

2011 ◽  
Vol 7 (1) ◽  
pp. 64-88 ◽  
Author(s):  
Rakhi P. Tripathi ◽  
M. P. Gupta ◽  
Jaijit Bhattacharya
Keyword(s):  
Literature Review ◽  
Process Integration ◽  
Current Level ◽  
Three Dimensions ◽  
Critical Factors ◽  
Integration Process ◽  
Horizontal Integration ◽  
It Professionals ◽  
One Stop ◽  
Government Portal

Interoperability is an important pre-condition for achieving higher stages of e-government and further ensures that a one stop portal will become a reality. Interoperability results from vertical and horizontal integration. The question arises: How can the level of interoperability and degree of integration be ascertained? This paper suggests a framework. It begins by identifying critical factors necessary for the successful adoption of interoperability technology along three dimensions of integration—process integration, communication integration, and data integration. Factors are formed from a literature review and discussions with webmasters and IT professionals working on portal development in various government departments of India. These factors are useful in further evaluation across the three dimensions and locate the position of a government portal in a technology adoption space. It is then possible to ascertain a portal’s current level of integration sophistication.

scholarly journals Pentoxifylline improves the quality of life in type-2 diabetes foot syndrome

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Marwan S Al-Nimer ◽  
Rawa A Ratha ◽  
Taha O Mahwi
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Diabetic Foot ◽  
Short Form ◽  
Diabetic Foot Syndrome ◽  
Controlled Study ◽  
Disability Score ◽  
Group I

Objectives: To evaluate the effect of pentoxifylline on the quality of life (QoL) in diabetic foot syndrome (DFS) by using Short Form-36 questionnaire, and in reference to the revised neuropathy disability score (RNDS) and grading of diabetic foot. Methods: This randomized placebo-controlled study was carried in the Department of Pharmacology at University of the Sulaimani through 2018. A total number of 80 T2D patients were recruited from outpatients Department attended the Center of Diabetes and the Shar Teaching Hospital in the University of Sulaimani, Sulaimani-Iraq. Group I (non-DFS, n=40) were subgrouped into Group-IA treated with placebo (n=20), and Group-IB treated with 400 mg pentoxifylline thrice daily for 8 weeks. Group II (DFS, n=40) sub grouped into Group-IIA treated with placebo (n=20), and Group-IIB treated with pentoxifylline. The primary outcome measures including the data of SF-36, RNDS, and grading of diabetic foot. Results: Pentoxifylline therapy significantly reduced the RNDS, improved the clinical evidence of diabetic foot, improved the QoL particularly the domains that related to emotional problems and physical health. Pentoxifylline offered a better effect in DFS compared with non-DFS patients Conclusion: Pentoxifylline treatment improves the quality of life in diabetic foot syndrome and its effect is related to the scoring of revised neuropathy disability and grading of diabetic foot. doi: https://doi.org/10.12669/pjms.35.5.11 How to cite this:Al-Nimer M, Ratha R, Mahwi T. Pentoxifylline improves the quality of life in type-2 diabetes foot syndrome. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.11 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Delayed Patient Access to Innovative Medical Technologies in South Korea: A Lead-Time Analysis of Reimbursement Coverage Determinations

2019 ◽  
Vol 35 (03) ◽  
pp. 229-236
Author(s):  
Sang-Soo Lee ◽  
Jae-Eun Myung ◽  
Liesl Strachan
Keyword(s):  
South Korea ◽  
Lead Time ◽  
Medical Procedure ◽  
Patient Access ◽  
Medical Technologies ◽  
Timely Access ◽  
One Stop ◽  
The Government ◽  
Average Lead ◽  
Open Datasets

AbstractBackground and ObjectivesTimely access to innovative medical technologies driven by accelerated patient access pathways can substantially improve the health outcomes of patients who often have few therapeutic alternatives. We analyzed lead-times for the medical procedure reimbursement coverage process undertaken in South Korea from 2014 to 2017, which is considered one of the most important factors contributing to delays in patient access to new medical technologies.MethodsThis analysis was performed using the open datasets source of “Medical Procedure Expert Evaluation Committee (MPEEC)” meeting results and medical procedure coverage application information published on the Health Insurance Review and Assessment Service Web site.ResultsFrom 2014 to 2017, 90 percent of all new coverage determinations took on average &gt;250 days with almost 20 percent taking more than 2 years (&gt;750 days), The average lead-time from the medical procedure coverage application to MPEEC meeting in 2015 was 435.0 ± 214.7 days (n= 26), which was significantly shorter than the average lead-time in 2014 (624.9 ± 290.3 days,n= 16) (p&lt; .05). The average lead-time from application to official enforcement in 2015 was significantly shorter than that of 2014 (540.8 ± 217.4; n = 16 versus 734.1 ± 299.7 days;n= 26, respectively) (p&lt; .05).ConclusionsWhile this analysis showed a general trend of a reduction in the time taken to receive a positive coverage determination for a new medical technology, the average lead-time remains well over the government mandated 100 days. To continue this trend and further enhance the patient access pathway for medical procedure coverage determinations, some measures can be applied. In particular, the extended “One-Stop Service” program encompassing coverage determinations is one such recommendation that could be considered.

scholarly journals Using Virtual Reality in Lumbar Puncture Training Improves Students Learning Experience

2021 ◽  
Author(s):  
Agathe Vrillon ◽  
laurent Gonzales-Marabal ◽  
Pierre-François Ceccaldi ◽  
Patrick Plaisance ◽  
Eric Desrentes ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Medical Students ◽  
Lumbar Puncture ◽  
Knowledge Retention ◽  
3D Video ◽  
Three Dimensions ◽  
University Hospital ◽  
Medical Procedure ◽  
Skills Acquisition ◽  
Wide Range

Abstract Background Lumbar puncture (LP) is a commonly performed medical procedure in a wide range of indications. Virtual reality (VR) provides a stimulating, safe and efficient learning environment. We report the design and the evaluation of a three dimensions (3D) video training for LP procedure.MethodsWe recorded a stereoscopic 180-degrees 3D video from two LPs performed in clinical setting in Fernand Widal Lariboisière University Hospital, Paris, France. Video was administrated to third-year medical students as well as to a residents and attendings group during LP simulation-based training sessions. ResultsOn 168 participants (108 novice third-year medical students, and 60 residents and attendings with prior LP experience), satisfaction after video exposure was high (rated 4.7 ± 0.6 on a 5-point scale). No significant discomfort was reported (comfort score graded 4.5 ± 0.8 on 5). LP-naive students displayed higher satisfaction and perceived benefit than participants with prior LP experience (overall, P < 0.05). Trainees evaluated favorably the 3D feature and supported the development of similar supports for other medical procedures (respectively, 3.9 ± 1.1 and 4.4 ± 0.9 on 5).ConclusionWe report our experience with a 3D video for LP training. VR support could increase knowledge retention and skills acquisition in association to LP simulation training.

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