Continuous Activity Monitoring in Persons at High Risk for Diabetes-Related Lower-Extremity Amputation

2001 ◽  
Vol 91 (9) ◽  
pp. 451-455 ◽  
Author(s):  
David G. Armstrong ◽  
Patricia L. Abu-Rumman ◽  
Brent P. Nixon ◽  
Andrew J.M. Boulton
Keyword(s):  
High Risk ◽  
Lower Extremity ◽  
Activity Monitor ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Continuous Activity ◽  
Steps Per Day ◽  
History Of ◽  
Extremity Amputation ◽  
Partial Foot Amputation

This study evaluated the magnitude and location of activity of diabetic patients at high risk for foot amputation. Twenty subjects aged 64.6 ± 1.8 years with diabetes, neuropathy, deformity, or a history of lower-extremity ulceration or partial foot amputation were dispensed a continuous activity monitor and a log book to record time periods spent in and out of their homes for 1 week. The results indicate that patients took more steps per hour outside their home, but took more steps per day inside their homes. Although 85% of the patients wore their physician-approved shoes most or all of the time while they were outside their homes, only 15% continued to wear them at home. Focusing on protection of the foot during in-home ambulation may be an important factor on which to focus future multidisciplinary efforts to reduce the incidence of ulceration and amputation. The ability to continuously monitor the magnitude, duration, and time of activity ultimately may assist clinicians in dosing activity just as they dose drugs. (J Am Podiatr Med Assoc 91(9): 451-455, 2001)

Benchmark Analysis on Diabetics at High Risk For Lower Extremity Amputation

1996 ◽  
Vol 17 (11) ◽  
pp. 695-700 ◽  
Author(s):  
Michael S. Pinzur ◽  
Rodney Stuck ◽  
Ronald Sage ◽  
Lisa Pocius ◽  
Bryan Trout ◽  
...  
Keyword(s):  
High Risk ◽  
Lower Extremity ◽  
Patient Care ◽  
Lower Limb ◽  
Lower Extremity Amputation ◽  
Organ System ◽  
Limb Amputation ◽  
Diabetic Patients ◽  
Benchmark Analysis ◽  
Extremity Amputation

After the 1990 establishment of a multidisciplinary foot salvage clinic, 1346 diabetic patients, at high risk for the development of foot ulcers and eventual lower limb amputation, were followed for 4 years. Of the 224 high-risk patients admitted to the hospital, 74 amputations (5.5%) of all or part of a lower limb were performed. Patients undergoing amputation were younger, more severely ill, and required more frequent hospitalizations because of greater organ system involvement. They were also more likely to be institutionalized after discharge. Overall, patients with long-standing adult-onset diabetes, identified as at high risk for foot ulcer development, have a substantially increased risk for lower limb amputation, multiple organ system failure, hospitalization, and institutionalization than do diabetic patients as a whole. Clinical benchmarking facilitates the identification and reduction of unnecessary variations in patient care practices. Here, a formal benchmark analysis provides the current outcome expectations for amputation rates and co-morbidities in patients with diabetes who are classified as at high risk for lower extremity amputation. Management of these patients in a structured, multidisciplinary foot salvage clinic, augmentation of baseline services, and preliminary benchmark data may provide a standard for the measurement of therapeutic interventions that improve patient care.

scholarly journals Potentially Preventable Hospitalizations and the Burden of Healthcare-Associated Infections

2017 ◽  
Vol 4 ◽  
pp. 233339281772110 ◽  
Author(s):  
Andrea L. Lorden ◽  
Luohua Jiang ◽  
Tiffany A. Radcliff ◽  
Kathleen A. Kelly ◽  
Robert L. Ohsfeldt
Keyword(s):  
Clostridium Difficile ◽  
Lower Extremity ◽  
Clostridium Difficile Infection ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Healthcare Associated Infections ◽  
Preventable Hospitalizations ◽  
Potentially Preventable Hospitalizations ◽  
Healthcare Associated ◽  
Extremity Amputation

Background: An estimated 4% of hospital admissions acquired healthcare-associated infections (HAIs) and accounted for $9.8 (USD) billion in direct cost during 2011. In 2010, nearly 140 000 of the 3.5 million potentially preventable hospitalizations (PPHs) may have acquired an HAI. There is a knowledge gap regarding the co-occurrence of these events. Aims: To estimate the period occurrences and likelihood of acquiring an HAI for the PPH population. Methods: Retrospective, cross-sectional study using logistic regression analysis of 2011 Texas Inpatient Discharge Public Use Data File including 2.6 million admissions from 576 acute care hospitals. Agency for Healthcare Research and Quality Prevention Quality Indicator software identified PPH, and existing administrative data identification methodologies were refined for Clostridium difficile infection, central line–associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia. Odds of acquiring HAIs when admitted with PPH were adjusted for demographic, health status, hospital, and community characteristics. Findings: We identified 272 923 PPH, 14 219 HAI, and 986 admissions with PPH and HAI. Odds of acquiring an HAI for diabetic patients admitted for lower extremity amputation demonstrated significantly increased odds ratio of 2.9 (95% confidence interval: 2.16-3.91) for Clostridium difficile infection. Other PPH patients had lower odds of acquiring HAI compared to non-PPH patients, and results were frequently significant. Conclusions: Clinical implications include increased risk of HAI among diabetic patients admitted for lower extremity amputation. Methodological implications include identification of rare events for inpatient subpopulations and the need for improved codification of HAIs to improve cost and policy analyses regarding allocation of resources toward clinical improvements.

Amputation and reamputation of the diabetic foot

1997 ◽  
Vol 87 (6) ◽  
pp. 255-259 ◽  
Author(s):  
DG Armstrong ◽  
LA Lavery ◽  
LB Harkless ◽  
WH Van Houtum
Keyword(s):  
Lower Extremity ◽  
Previous History ◽  
Arterial Disease ◽  
Lower Extremity Amputation ◽  
South Texas ◽  
Diabetic Patients ◽  
Amputation Level ◽  
Causal Pathway ◽  
Peripheral Arterial ◽  
Extremity Amputation

The authors compare the level of foot amputation by age, prevalence of arterial disease as a precipitating factor, gender, and ethnicity in persons with diabetes mellitus. Medical records were abstracted for each hospitalization for a lower extremity amputation from January 1 to December 31, 1993, in six metropolitan statistical areas in south Texas. Amputation level was defined by ICD-9-CM codes and were categorized as foot, leg, and thigh amputations. Foot-level amputations were further subcategorized as hallux or first ray, middle, fifth, multiple digit or ray, and midfoot amputations. Only the highest amputation level for each individual was used in the analysis. Of 1,043 subjects undergoing a lower extremity amputation in south Texas in the year 1993, 477 received their amputation at the level of the foot. African-Americans requiring a foot-level amputation were at significantly higher risk to undergo a midfoot-level amputation than was the rest of the population. Nearly 40% of all subjects undergoing a foot-level amputation had a previous history of amputation. However, nearly 40% of subjects undergoing foot amputations had not been diagnosed either before or during admission with peripheral arterial occlusive disease, suggesting a causal pathway dependent primarily on neuropathy. This implies that better screening of diabetic patients with appropriate risk-directed treatment at the primary care level may significantly impact the large number of preventable diabetes-related lower extremity amputations.

Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death

2017 ◽  
Vol 11 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Dane K. Wukich ◽  
Katherine M. Raspovic ◽  
Natalie C. Suder
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Lower Extremity Amputation ◽  
Controlled Study ◽  
Control Group ◽  
Diabetic Patients ◽  
Charcot Neuroarthropathy ◽  
Diabetic Foot Disease ◽  
Foot Disease ◽  
Extremity Amputation

Background. The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology. Methods. We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non–diabetes-related foot pathology. Results. A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease. Conclusion. Patients with diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy. Levels of Evidence: Level II: Prospective, Case controlled study

Lower Extremity Amputation in Diabetic Patients

Diabetes ◽  
1970 ◽  
Vol 19 (3) ◽  
pp. 189-195 ◽  
Author(s):  
M. L. Ecker ◽  
B. S. Jacobs
Keyword(s):  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Extremity Amputation

scholarly journals Increased Risk of Lower-Extremity Amputation Among Caucasian Diabetic Patients on Dialysis

Diabetes Care ◽  
2001 ◽  
Vol 24 (9) ◽  
pp. 1689-1690 ◽  
Author(s):  
S. Morbach ◽  
C. Quante ◽  
H. R. Ochs ◽  
F. Gaschler ◽  
J.-M. Pallast ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Extremity Amputation

scholarly journals NON –TRAUMATIC LOWER EXTREMITY AMPUTATIONS IN DIABETICS

2012 ◽  
Vol 19 (05) ◽  
pp. 615-619
Author(s):  
Muhammad ATEEQ ◽  
ABID BASHIR ◽  
SHAZIA JEHAN
Keyword(s):  
Lower Extremity ◽  
Teaching Hospital ◽  
Care Service ◽  
Health Care Service ◽  
Lower Extremity Amputation ◽  
Amputation Rate ◽  
Diabetic Patients ◽  
Foot Care ◽  
Cross Sectional ◽  
Extremity Amputation

Objective: The purpose of this study was to estimate the prevalence of non -traumatic lower extremity amputations in diabetic inperipheral teaching hospital catchment area. Study Design: Prospective, Cross sectional, Interventional. Setting: Surgical Unit II. Aziz BhattiShaheed (Teaching) Hospital. Nawaz Sharif medical College, University of the Gujrat. Study Period: February 1, 2011 to January 31, 2012.Results: A total of 132 patient were subjected to non traumatic lower extremity amputation were enrolled in this study out of which 89 (67.42%)were diabetic, followed by non specific infections n=39 (23.48) Out of 89 total diabetic patients 53 (40.15%) patients were female whereas 36(27.27%) were male. Both major and minor non traumatic lower extremity amputation rate was more in female diabetic patients than malediabetics. Conclusions: The prevalence of non –traumatic below knee amputations at an early age is high in our diabetic patients, especially infemale population. By improving primary health care service regarding foot care awareness in diabetics appears to be the main way to reducethe amputation rate.

scholarly journals Risk Factors for Lower Extremity Amputation in Diabetic Foot Ulcer Patients: A Case-Control Study

2020 ◽  
Vol 11 (2) ◽  
pp. 83
Author(s):  
Gusti Agung Ayu Ira Kencana Dewi ◽  
Sony Wibisono ◽  
I Putu Alit Pawana
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Diabetic Foot ◽  
Medical Records ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Extremity Amputation ◽  
History Of ◽  
Extremity Amputation ◽  
Control Study

Introduction: Diabetes mellitus is a metabolic syndrome that is marked by higher blood glucose. The uncontrolled high blood glucose can lead to complication, such as diabetic foot. Diabetic foot is the most reason why diabetic patients are hospitalized. Diabetic foot that cannot heal may lead to lower extremity amputation. The purpose of this study was to describe the risk factors of lower extremity amputation in diabetic foot ulcer patients.Methods: This study used a case-control study of diabetic foot patients in Dr. Soetomo General Hospital from January 2015 to December 2017. This study used the data from medical records in Inpatient Installation Department of Internal Medicine. Patients with diabetic foot ulcer and lower extremity amputation due to diabetes were included in this study. Incomplete medical records were excluded. Data of samples were divided to two groups, i.e. the amputation group and the non-amputation group with a ratio of 1:1. Risk factors of amputation that were analyzed were male, old age, and the history of ulcer/lower extremity amputation.Results: Based on the data of 36 samples, there were 11 male patients (61.1%) and 7 female patients (38.9%) who experienced lower extremity amputation. The average age of amputation group was 59.61 years old with a range of ages from 39 to 72 years old. This study found the risk factors for lower extremity amputation in diabetic foot ulcer patients was the history of ulcer/amputation due to diabetes (OR 5.0, 95% CI 1.065-23.464, p = 0.034). Conclusion: The risk factor for lower extremity amputation in diabetic foot ulcer patients was the history of ulcer/amputation due to diabetes. 

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