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OBJECTIVE: To determine the rate of different amputation levels in diabetic foot patients and the incidence of repetitive foot surgeries and evaluate the factors causing a delay in hospital stay and amputation of patients. METHODOLOGY: This prospective cohort study was conducted in Dr. Ruth K.M. Pfau, Civil Hospital Karachi, Pakistan. The study selected 375 participants from the clinic's daily patient inflow from October 2021 to March 2022 using a non-probability consecutive sampling technique. Those who had a delay in hospital stay and amputation were further followed up from May-October 2022. The chi-square test and Kruskal Wallis test (p-value <0.05) were used to correlate the effect of the level of lower limb amputation and the cause of delay in amputation using SPSS version 24.0. RESULT(S): Total 246(65.60%) were males and 129(34.40%) were females. Toe amputation was the most commonly seen amputation in 173(46.1%) participants. About 168(44.8%) patients had some in-hospital delay stay during their treatment. Preoperative hurdles (Uncontrolled RBS, Osteomyelitis, etc.) were the most common factor causing an in-hospital delay in 92(24.5%) patients. The level of amputation performed was found to be statistically significant with factors causing a delay in hospital stay through chi-square (p=0.003*) and Kruskal Wallis test H (2) statistic= 13.3, df = 3, H (2), P=0.004*). CONCLUSION(S): Diabetic foot is a frequent cause of amputation globally, majorly in developing countries like Pakistan. On-time provision of treatment to these patients can decline the global amputation rate due to diabetic foot ulcers.Copyright © 2023 Syeda Anjala Tahir.
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Aim: Diabetic foot ulcers (DFUs) are linked to morbidity, decreased mobility, and feelings of isolation, powerlessness and sadness. The aim of our study was to explore the prevalence of anxiety and depression symptoms in adult patients with DFU. Method(s): We analysed questionnaires completed by patients with DFU attending our University Hospital Multidisciplinary Foot Clinic service over a one-month period in March 2022. The patients had completed three questionnaires, comprising of questions relating to socio-demographic status and care perceptions, the Patient Health Questionnaire-9 (PHQ-9) scale to assess depression, and the Generalized Anxiety Disorder scale (GAD-7) to assess anxiety. Result(s): Of the 60 patients who completed the questionnaires, 35% (n=21) reported anxiety symptoms and 40% (n=24), depressive symptoms. Individuals with comorbidities were three times more likely to report depression relative to those without any comorbidities (OR 3.3;95% CI 1.13-12.56). Younger individuals (less than 50 years), were almost nine times more likely to report anxiety in comparison to those aged 60 years or more (adjusted OR 8.9;95% CI 1.01-86.41), despite adjustment for confounding variables. Conclusion(s): The prevalence of depression and anxiety in this cohort of patients with DFU was low, but those who were affected reported moderate to severe symptoms. Younger individuals and those with comorbid conditions with DFU are more likely to experience an adverse impact on their mental health. This is a crucial factor to consider in the management of people undergoing DFU care. Strategies to reduce anxiety and/or depressive symptoms could impact both quality of life and wound healing. Copyright © 2023 John Wiley & Sons.Copyright © 2023 John Wiley & Sons, Ltd.
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Diabetic foot disease is a severe invalidiza-ting complication of diabetes mellitus, which is associated with significant comorbidity, reduced life expectancy and quality of life of the affected person, and with several fold increased burden for health care system as well. It is the leading cause for non-traumatic lower limb amputations. According to its features, diabetic foot disease is a heterogeneous condition. In its pathogenesis are combined metabolic, hemodynamic, mechanical, infectious and genetic factors. There is no single evaluation scale for this diabetic complication, but are present different classifications, which account for neurological, vascular and structural damage, inflammatory state, concomitant diseases, previous ulcers and amputations. In this way, risk category of each patient is defined, which determines the therapeutical plan, the need for hospitalization, the prognosis and the follow-up interval. Due to its multifactorial aspects, diabetic foot disease is approached in interdisciplinary manner. Integrated foot care by highly skilled specialists in combination with structured patient education about self-care and self-monitoring, could reduce diabetic foot wounds with up to 85%. It is also estimated that in 85% of cases lower limb amputations among people withdiabetes are pre-ceded by ulcers, which highlights the significance of the aforementioned measures. During COVID-19 pandemic there are additional risks for worsening of people with diabetic foot. In conclusion, in most cases diabetic foot disease and its consequences are potentially preventable, which determines the paramount importance of revising and timely applying the latest guidelines on its diagnosis and management.Copyright © 2021 Medical Information Center. All rights reserved.
ABSTRACT
Diabetic foot disease is a severe invalidiza-ting complication of diabetes mellitus, which is associated with significant comorbidity, reduced life expectancy and quality of life of the affected person, and with several fold increased burden for health care system as well. It is the leading cause for non-traumatic lower limb amputations. According to its features, diabetic foot disease is a heterogeneous condition. In its pathogenesis are combined metabolic, hemodynamic, mechanical, infectious and genetic factors. There is no single evaluation scale for this diabetic complication, but are present different classifications, which account for neurological, vascular and structural damage, inflammatory state, concomitant diseases, previous ulcers and amputations. In this way, risk category of each patient is defined, which determines the therapeutical plan, the need for hospitalization, the prognosis and the follow-up interval. Due to its multifactorial aspects, diabetic foot disease is approached in interdisciplinary manner. Integrated foot care by highly skilled specialists in combination with structured patient education about self-care and self-monitoring, could reduce diabetic foot wounds with up to 85%. It is also estimated that in 85% of cases lower limb amputations among people withdiabetes are pre-ceded by ulcers, which highlights the significance of the aforementioned measures. During COVID-19 pandemic there are additional risks for worsening of people with diabetic foot. In conclusion, in most cases diabetic foot disease and its consequences are potentially preventable, which determines the paramount importance of revising and timely applying the latest guidelines on its diagnosis and management.Copyright © 2021 Medical Information Center. All rights reserved.
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Introduction and Objectives: Limited healthcare access and resource inequities pose significant barriers to care, all of which have been amplified during the COVID-19 pandemic. DFUs represent an especially challenging medical problem to prevent and treat due to the resource intensive care required. We sought to evaluate the feasibility of multidisciplinary, mobile, DFU outreach clinics to improve access to care. Method(s): Our clinic model focused on creating mobile diabetic foot clinics staffed by volunteer clinical providers who specialize in Vascular Surgery, Diabetes, and Podiatry. We recruited volunteer healthcare providers from an academic medical center. We partnered with local community centers with established programs providing services to unhoused individuals. Result(s): Between June 2020 and August 2022, a total of 130 unhoused individuals were seen at four mobile clinics set up at different locations. Diabetic foot care was provided by volunteers from seven departments: Endocrinology/Diabetes, Vascular Surgery and Vascular Lab, Podiatry, Addiction Medicine, Smoking Cessation, and Financial. On average, 32 healthcare provider volunteers participated at each clinic. Services provided include: vitals, blood glucose, HgA1c, lipid panel testing, ankle-brachial index, podiatric exam, wound care, medical education, COVID vaccination/booster, insurance enrollment, and new socks and shoes. Of 130 unhoused patients, 29% had hypertension (38), 34% had abnormal ABI (44), and 14% had diabetes (18). Fifteen patients were further identified as high risk for developing DFU-associated amputation (12%) and were provided with ambulatory follow-ups. Conclusion(s): In our pilot experience, it is feasible to provide consistent comprehensive DFU care through mobile outreach clinics. By using the infrastructure of partner organizations and healthcare expertise of an academic center, our clinics could integrate into existing community services. [Formula presented]Copyright © 2022
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Aim: Diabetic foot ulcers (DFU) are linked to morbidity, decreased mobility, and feelings of isolation, powerlessness and sadness. The aim of this study was to explore the prevalence of anxiety and depression symptoms in adult patients with DFU. Method(s): Patients with DFU attending our multidisciplinary diabetic foot clinic from February 14th to March 14th, 2022 were invited to complete a questionnaire which included sociodemographic questions, the Patient Health Questionnaire-9 (PHQ-9) scale to assess depression and the Generalized Anxiety Disorder scale (GAD-7) to assess anxiety. For each scale, a cut-off total score of 10 was used to identify those who met the criteria for anxiety and depression. Result(s): 60 patients completed the questionnaire. 83.25% of the participants reported that their diabetes foot care had not been affected by the COVID-19 pandemic. 25% reported moderate to severe anxiety symptoms, 10% reported mild anxiety symptoms while 65% reported no or minimal anxiety symptoms. Regarding depression, 30% reported moderate to severe depressive symptoms, 10% reported mild depressive symptoms, while 60% reported no or minimal depression (Figure 1). Patients with other co-morbidities were three times more likely to report depression compared to those without other co-morbidities (OR=3.2;95% CI 1.10-10.26). Patients younger than 50 years were nearly nine times more likely to report anxiety compared to those aged 60 years or above (adjusted OR=8.9;95% CI: 1.01-86.41) taking into account other variables. Conclusion(s): The prevalence of depression and anxiety in this cohort of patients with DFU was low, but the severity was moderate to severe in those who were affected. Patients with other co-morbidities and those younger than 50 years have worse mental health status. This finding needs to be taken into account in the management of patients with DFU. Attempts to reduce anxiety and/or depression could improve the quality of life of DFU patients.
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Objectives: To determine optimal strategies for diabetic foot care in times of pandemic. Methods: Systematic review was conducted following PRISMA guidelines from May to December 2021, using Pubmed, Scopus, SCIelo, CINAHL and Lilacs databases, with the descriptors DeCs: Diabetic foot, (diabetic foot) AND: (disease prevention), (nursing care), (nursing care), (nursing care)) AND (disease prevention), (nursing care) AND (Strategies), (Coronavirus infections), (Coronavirus infections) Queries Covid-19 articles Category: General, ((diabetic foot) AND (nursing care)) AND (Coronavirus infections). Studies from 2018 to August 2021 were considered. Results: Out of 2464 articles, 28 were selected and evaluated using the Mixed Methods Appraisal Tool. 29% articles (8) were developed in countries belonging to Europe, followed by 25% (7) articles from countries in Asia and North America, 14% (4) from countries in South America and 4% (1) article from Oceania and Africa. The results obtained were differentiated between face-to-face and non-face-to-face strategies. Within the latter group, the lines of action defined in the Chilean National Telehealth Program were used to classify the results. Conclusions: The optimal strategies for diabetic foot care in times of pandemic were classified as face-to-face and non-face-to-face. As face-to-face strategy, foot care education and complications were identified. As non-face-to-face strategies, are those focused on the use of tele-education for patients and te-learning for professionals, in addition to support in the evaluation of lesions with telemedicine, tele-assistance, telemonitoring and telefolow-ups. The elements inherent to e-health should be considered, such as: infrastructure, collaboration with the private, associative and multisectoral sectors, evaluations of cost-effective models, adaptation of services to the needs of the population, particularly vulnerable groups.
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BACKGROUND: The COVID-19 pandemic has directly affected the delivery of health care services in Canada, including foot care. The goal of this descriptive study was to understand the impact of the early COVID-19 pandemic (March 2020 to April 2021) on chiropodists' and podiatrists' clinical practices and foot care service delivery in Ontario, Canada. METHODS: A web-survey was completed by participating chiropodists and podiatrists registered with the College of Chiropodists of Ontario. The survey consisted of 31 multiple choice and open-ended items on clinical practice characteristics, foot care service delivery changes, perceived barriers during the pandemic, and its impact on clinicians. Descriptive statistics were used to characterize the sample and examine clinicians' responses, and qualitative content analysis was used to explore opened-ended items. RESULTS: Of the 773 eligible clinicians, 279 participated for a response rate of 36.1%. Most respondents reported a decline in patient volume, an increase in urgent foot health problems, a financial impact on their clinical practices, an emotional impact, and substantial changes to how they provided foot care services, such as incorporating telehealth/virtual care into patient care. Factors that impact clinicians' perception of future pandemic preparedness are identified. CONCLUSION: This study describes foot care service delivery in Ontario, Canada during the COVID-19 pandemic. The COVID-19 pandemic saw an increase in urgent foot health problems, decline in patient volume, and impacted clinicians' mental health and emotional well-being. Future studies should examine patients' experiences of foot care service delivery and maintaining their foot health during the pandemic, and further examination of factors that impact clinicians' perception of pandemic preparedness.
Subject(s)
COVID-19 , Delivery of Health Care , Telemedicine , COVID-19/epidemiology , Foot Diseases/diagnosis , Foot Diseases/therapy , Humans , Ontario/epidemiology , Pandemics , Patient CareABSTRACT
Background: About 10% of patients with type 2 diabetes mellitus at the time of diagnosis have more than one risk factor for developing foot ulceration, and it increases to 15% in a lifetime. The risk of development of Diabetic foot ulcers/gangrene can be prevented by the patient's self-foot care practice at home. The present study aimed to determine the prevalence of awareness of self-foot care practice among diabetic patients in a rural setting. The study also aimed to identify the factors preventing dry or wet diabetic gangrene development and subsequent amputation. Methods: A hospital-based cross-sectional study was carried out among 1687 people with diabetes mellitus (DM) who attended orthopedic and diabetic OPD in a tertiary care hospital in Kamrup, Assam, India. An appropriate self-explanatory questionnaire about knowledge of self-foot care practice was given to all study participants. Foot examination was performed by authors participated in the study on all patients. The observations and results were categorized according to the International Diabetes Federation foot risk categories. Results: Of 1687 patients included in this study, 298 (17.7%) had foot ulcers of various grades, 164 (9.76%) had peripheral vascular disease, and 484 (28.7%), had peripheral neuropathy of different grades. After multivariate analysis, patients on insulin and combination therapy and peripheral neuropathy were significantly associated with the presence of foot ulcers. The mean knowledge score was as low as 9.7 ± 4.8 out of a total score of 23. Low awareness and knowledge were associated with low mean scores due to a lack of formal education (8.3 ± 6.1). Among the 1687 patients, only 381 (22.5%) are aware and have some knowledge about self-foot care, and 686 (40.6%) had their feet examined by a doctor only once since their initial diagnosis. The incidence of development of diabetic-related complications was significantly low in those who know about foot self-care as well as those whose feet had been inspected by a physician at least once. Conclusion: The incidence of development of diabetic-related complications was significantly low in those who know about foot self-care as well as those whose feet had been examined by a physician of family doctors at least once. There is a need to educate all patients of diabetes about self-foot care. It is prudent to establish an integrated foot care services within primary care centers and in the diabetic clinic to identify feet at risk, institute early preventive measures, and provide continuous foot care education through images videos on WhatsApp to patients and primary health care givers.
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Background: The COVID-19 pandemic produced extreme challenges for the delivery of safe and effective diabetes foot services at every level. This retrospective study (April 2020 to March 202) at Ipswich Hospital shows that, despite the challenges, adoption of innovative measures including change of referral pathways and templates, clinical triaging and liaisons with primary care services can still be effective in the delivery of safe and effective diabetic foot care. Results and outcomes: The total number of patients reviewed in secondary care during COVID-19 was 505 compared with 622 in the previous year (209-2020);the number of individual appointments attended was 2,754 (2,950). Similarly, hospital inpatient referrals were 380 with 736 reviews compared with 506 with ,028 reviews in the preceding year. During COVID-19, average HbA1c for diabetes foot patients was 8 . 2 ± . 7 5% (7.67±2.2%), uACR was 24.3±68.83 (24.32±72.38) and total cholesterol 4.9±.63 (3.97±.95). The total number of angioplasty procedures performed during COVID-19 was 44 (45), lower limb bypasses 5 (4) and lower limb endarterectomies 8 (6). During COVID-19 major amputations were 9 (5) and minor amputations 35 (43). Mortality in diabetic foot subjects was 52 (47) equating to 0 . 3% (7.5%) of the outpatient caseload. Conclusion: Compared with the pre-COVID-19 data, the outcomes obtained during COVID-19 demonstrate the importance of access to diabetic foot services in mitigating the risk of complications during a pandemic. Our data suggest appropriate early planning, close liaisons with care providers and timely interventions were key in reducing morbidity and mortality due to diabetic foot complications.
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Globally, the prevalence of diabetes has risen significantly by 62% over the last ten years. A complication of unmanaged diabetes is diabetic foot ulcer (DFU), which adversely affects the quality of life of individuals with diabetes and inflicts a huge economic burden on the family, government, and health care services. However, this complication is preventable with adequate patient knowledge and practice regarding DFU and foot care. The present study was aimed at assessing the knowledge, attitude, and practice of adults with diabetes on foot ulcers and foot care in Tobago using a qualitative exploratory design. Purposeful sampling technique was used to recruit 20 participants from the lifestyle and diabetes foot clinics of Scarborough Health Centre, Tobago. Telephone interviews were conducted with the use of a semi-structured interview guide. The data obtained from participants were analyzed using thematic content analysis. Four major themes, namely foot ulcer problems, participants' knowledge on DFU, knowledge on foot care, and practice and attitude of foot care, emerged from the study. The findings from the study revealed that the majority of participants had poor knowledge regarding DFU but exhibited awareness about foot care, especially on foot cleaning and inspection, preventing irritation after washing, appropriate footwear, and not walking barefooted. The participants had good attitudes and practices of foot care despite their poor knowledge of DFU. However, participants reported inadequate health education on DFU and foot care from healthcare personnel. There should be improved health education, information, and communication on DFU and foot care centred and tailored to the understanding of people living with diabetes. This will prevent DFU and reduce the mortality arising from this complication, which is a major target of the sustainable development goals (SDG) in mitigating the burden of non-communicable diseases (NCD) such as diabetes.
Subject(s)
Diabetes Mellitus , Diabetic Foot , Adult , Diabetic Foot/epidemiology , Diabetic Foot/prevention & control , Health Knowledge, Attitudes, Practice , Humans , Quality of Life , Trinidad and Tobago , WalkingABSTRACT
People with diabetes have a higher risk of lower-limb amputations than people without diabetes. The risk of avoidable lower-limb amputations has increased in the coronavirus disease 2019 (COVID-19) lockdown period. Hence, we conducted a retrospective, single-centered study on major amputations during the prepandemic period (March 25, 2019-December 31, 2019) and pandemic period (March 25, 2020-December 31, 2020). During the prepandemic period, 24 major amputations (below-knee and above-knee amputations) were performed and during the pandemic period, 37 major amputations were performed. There was a 54.1% increase in major amputations noted in the pandemic period more than the prepandemic period. This increase may also be due to irregular/missed hospital visits, improper diet, nonadherence to the medications, and physical inactivity. This study shows the indirect effect of the COVID-19 pandemic on people with diabetes, resulting in the increased incidence of lower-extremity amputations (below-knee and above-knee amputations) which might cause a drastic impact on their quality of life. This study also emphasizes the importance of easy and routine access to foot-care specialists to prevent avoidable amputations.