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1.
J Prim Care Community Health ; 13: 21501319221089767, 2022.
Article in English | MEDLINE | ID: covidwho-1765396

ABSTRACT

BACKGROUND: Diabetic foot ulcer (DFU) is one of the most terrifying diabetic complications for patients, due to the high mortality rate and risk for amputation. During the COVID-19 pandemic, many diabetic patients limited their visits to the hospital, resulting in delays for treatment especially in emergency cases. OBJECTIVE: This study aimed to compare the characteristics of patients with DFU pre- and during COVID-19 pandemic period. Methods: This study was a retrospective cohort study using foot registry data. We compared our patients' characteristics pre-COVID-19 pandemic period (1 March 2019-28 February 2020) and during COVID-19 pandemic period (1 March 2020-28 February 2021). RESULTS: Cohorts of 84 and 71 patients with DFU pre- and during COVID-19 pandemic period, respectively, were included in this study. High infection grade (66.7% vs 83.1%, P = .032), osteomyelitis event (72.6% vs 87.3%, P = .04), leukocyte count (15 565.0/µL vs 20 280.0/µL, P = .002), neutrophil-to-lymphocyte ratio (7.7 vs 12.1, P = .008), waiting time-to-surgery (39.0 h vs 78.5 h, P = .034), and number of major amputation (20.2% vs 39.4%, P = .014) were significantly higher during the COVID-19 pandemic period. CONCLUSION: During the COVID-19 pandemic, patients with DFU had more severe infection, higher proportion of osteomyelitis, longer waiting time for getting surgical intervention, and higher incidence of major amputation.


Subject(s)
COVID-19 , Diabetes Mellitus , Diabetic Foot , COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Diabetic Foot/surgery , Diabetic Foot/therapy , Hospitals , Humans , Indonesia/epidemiology , Pandemics , Referral and Consultation , Retrospective Studies , Risk Factors
2.
Foot (Edinb) ; 50: 101872, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1712622

ABSTRACT

Telemedicine (TM) has been advanced as an effective approach to wound care management. In this era of COVID-19 pandemic, it is paramount to assess the evidence behind the use of TM in treating diabetic foot ulcers (DFU). This meta-analysis aims at evaluating the efficacy of TM versus face-to-face attendance in managing DFU. In total, four controlled studies were included in the meta-analysis comprising 3 randomized trials. The total pooled sample comprised 816 patients (816 ulcers): 337 in TM group and 479 in the control group. The results were as follows: (a) healing rate OR was 1.35, in favor of TM (p = 0.4), (b) time to heal with means of 73 ± 24.1 days and 83.5 ± 28.4 days, for the TM and control group, respectively (p = 0.35), c) the amputation rate OR was 0.48 (p = 0.007) in favor of the TM group, d) the mortality rate OR was 1.66 (p = 0.2), and e) a trend for lesser cost than face-to-face group (p = 0.4). While future research using large-sampled controlled studies is warranted, the present meta-analysis demonstrated that treating DFU via TM could be at least as effective as to face-to-face attendance. In times where clinic visits are reduced or not possible such as during this COVID-19 pandemic and the likely-to-happen future outbreaks, TM could be a valuable alternative.


Subject(s)
COVID-19 , Diabetes Mellitus , Diabetic Foot , Telemedicine , COVID-19/epidemiology , Diabetic Foot/therapy , Humans , Pandemics , SARS-CoV-2
3.
Int J Low Extrem Wounds ; 21(2): 107-110, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1709223

ABSTRACT

Diabetic foot syndrome (DFS) is a major complication of diabetes mellitus. Coronavirus infectious disease 2019 (COVID-19) has created new necessities and priorities in DFS management. These include telemedicine and patient triage to minimise hospitalisation and visits to the clinic. Moreover, new studies will be needed to evaluate whether the lockdown in patients with DFS or in those with high risk of DFS have increased the risk of deteriorating outcomes, including limb loss. Our future challenge will lie in re-organising our world during the pandemic and after its resolution. We need more awareness of the widespread ways of the changes in taking care of patients and to improve education, skills, and behaviour of high-risk patients.


Subject(s)
COVID-19 , Communicable Diseases , Diabetes Mellitus , Diabetic Foot , Communicable Disease Control , Diabetic Foot/diagnosis , Diabetic Foot/epidemiology , Diabetic Foot/therapy , Humans , Pandemics
4.
Diabetes Metab Res Rev ; 38(4): e3520, 2022 05.
Article in English | MEDLINE | ID: covidwho-1648801

ABSTRACT

AIMS: During the Covid-19 epidemic, many countries imposed population lockdown. This study aimed to analyse diabetic foot ulcer (DFU) evolution of outpatients between the lockdown period and 1 month after its end. MATERIALS AND METHODS: We conducted a prospective, observational, single-centre study without modification of care. All patients who followed up for a DFU in the study centre between 15 April 2020 and 11 May 2020 were included. The baseline assessment occurred 4 weeks after the beginning of lockdown and the follow-up visit 4-6 weeks after easing of lockdown. The primary analysis was based on the Site, Ischaemia, Neuropathy, Bacterial infection, Area, Depth (SINBAD) classification. RESULTS: Twenty-seven patients were included, median 69.4 years, and 25 were followed-up at easing of lockdown. The median SINBAD score was 2 (interquartile range 1; 3) at inclusion and 1 (1; 2) at easing of lockdown, with a mean change of -0.32 (95% confidence interval -0.93; 0.29). Seventy-two percent of the population had a stable or improved score between the two visits. The proportion of patients using off-loading footwear was higher among those whose SINBAD score improved compared to those whose score worsened or remained stable (72%, 44% and 28%, respectively). Diabetes type was linked to DFU prognosis. Five patients (20%) were hospitalized during the follow-up period. CONCLUSION: Lockdown appears to have had a positive effect on DFU if patients remain under the care of their expert wound centre. We believe this effect is related to better compliance with offloading. The wide use of tele-medicine seems relevant for the follow-up of DFU.


Subject(s)
COVID-19 , Diabetes Mellitus , Diabetic Foot , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Diabetic Foot/epidemiology , Diabetic Foot/prevention & control , Hospitalization , Humans , Prospective Studies
5.
JAMA Netw Open ; 5(1): e2142354, 2022 01 04.
Article in English | MEDLINE | ID: covidwho-1604496

ABSTRACT

Importance: Deferred diabetic foot screening and delays in timely care of acute foot complications during the COVID-19 pandemic may have contributed to an increase in limb loss. Objective: To evaluate the association of the COVID-19 pandemic with diabetes-related care measures, foot complications, and amputation. Design, Setting, and Participants: This population-based cohort study included all adult residents of Ontario, Canada, with diabetes and compared the rates of selected outcomes from January 1, 2020, to February 23, 2021, vs January 1, 2019, to February 23, 2020. Main Outcomes and Measures: Comprehensive in-person diabetes care assessment, including foot examination; hemoglobin A1c (HbA1c) measurement; emergency department visit or hospitalization for diabetic foot ulceration, osteomyelitis, or gangrene; lower extremity open or endovascular revascularization; minor (toe or partial-foot) amputation; and major (above-ankle) leg amputation. Rates and rate ratios (RRs) comparing 2020-2021 vs 2019-2020 for each measure were calculated for 10-week periods, anchored relative to onset of the pandemic on March 11, 2020 (11th week of 2020). Results: On March 11, 2020, the study included 1 488 605 adults with diabetes (median [IQR] age, 65 [55-74] years; 776 665 [52.2%] men), and on March 11, 2019, the study included 1 441 029 adults with diabetes (median [IQR] age, 65 [55-74] years; 751 459 [52.1%] men). After the onset of the pandemic, rates of major amputation in 2020-2021 decreased compared with 2019-2020 levels. The RR for the prepandemic period from January 1 to March 10 was 1.05 (95% CI, 0.88-1.25), with RRs in the pandemic periods ranging from 0.86 (95% CI, 0.72-1.03) in May 20 to July 28 to 0.95 (95% CI, 0.80-1.13) in October 7 to December 15. There were no consistent differences in demographic characteristics or comorbidities of patients undergoing amputation in the 2020-2021 vs 2019-2020 periods. Rates of comprehensive in-person diabetes care assessment and HbA1c measurement declined sharply and remained below 2019-2020 levels (eg, in-person assessment, March 11 to May 19: RR, 0.28; 95% CI, 0.28-0.28). The rates of emergency department visits (eg, March 11 to May 19: RR, 0.67; 95% CI, 0.61-0.75), hospitalization (eg, March 11 to May 19: RR, 0.77; 95% CI, 0.68-0.87), open revascularization (eg, March 11 to May 19: RR, 0.66; 95% CI, 0.56-0.79), endovascular revascularization (March 11 to May 19: RR, 0.70; 95% CI, 0.61-0.81), and minor amputation (March 11 to May 19: RR, 0.70; 95% CI, 0.60-0.83) initially dropped but recovered to 2019-2020 levels over the study period. Conclusions and Relevance: In this population-based cohort study, disruptions in care related to the COVID-19 pandemic were not associated with excess leg amputations among people living with diabetes. As the pandemic ends, improved prevention and treatment of diabetic foot complications will be necessary to maintain these positive results.


Subject(s)
Amputation , COVID-19 , Delivery of Health Care/methods , Diabetes Mellitus , Diabetic Foot/surgery , Pandemics , Aged , COVID-19/epidemiology , Cohort Studies , Comorbidity , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Diabetic Foot/epidemiology , Diabetic Foot/therapy , Emergency Service, Hospital , Female , Foot/pathology , Foot/surgery , Glycated Hemoglobin A , Hospitalization , Humans , Male , Middle Aged , Ontario/epidemiology , Physical Examination , SARS-CoV-2 , Vascular Surgical Procedures
6.
Am J Case Rep ; 22: e933879, 2021 Dec 15.
Article in English | MEDLINE | ID: covidwho-1574779

ABSTRACT

BACKGROUND Wounds affect millions of people world-wide, with care being costly and difficult to deliver remotely. The ongoing COVID-19 pandemic highlights the urgent need for telehealth solutions to play a larger role as part of remote care strategies for patient monitoring and care. We describe our findings on the use of a patient-facing wound care app (Swift Patient Connect App, Swift Medical, Canada) as an innovative solution in remote wound assessment and management of a diabetic patient's wound. CASE REPORT In February 2020, a 57-year-old man with type I diabetes and peripheral arterial disease presented with osteomyelitis in the left foot at the fifth metatarsal, arising from a chronic ulcer. The wound was deep, with purulent discharge and polymicrobial growth. A 6-week course of intravenous antibiotics was administered, with slow improvement of the wound. At a follow-up appointment in June 2020, The Patient Connect app was recommended to the patient to securely share calibrated images of his wound as well to communicate with his doctor. Between June 2020 and January 2021, wound closure was accurately monitored as part of the management of this diabetic foot infection. The app was also used in the management of 2 subsequent wounds and infection episodes. CONCLUSIONS Use of the Swift Patient Connect App designed to monitor and manage wounds by a patient with diabetes and foot ulcer as part of a remote care strategy resulted in numerous benefits expressed by the patient. After initial adoption, 3 successive wounds were managed with a combination of in-person and telehealth visits complemented by the app. Incorporation of this technology as part of a novel telemedicine strategy promises to have an extensive impact on remote care delivery during the current COVID-19 pandemic and beyond.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Foot , Mobile Applications , Diabetes Mellitus, Type 1/complications , Diabetic Foot/therapy , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Smartphone
8.
Regen Med ; 16(12): 1051-1056, 2021 11.
Article in English | MEDLINE | ID: covidwho-1438395

ABSTRACT

Diabetic foot infection is frequent in diabetic patients and is due to neuropathy, trauma or peripheral arterial disease. The presence of an abscess requires urgent drainage and specific antibiotic therapy. Patients with critical limb ischemia need revascularization and, subsequently the intervention of a plastic surgeon is often required in cases of exposure of tendons and ligaments. During the COVID-19 pandemic, a patient was refered to our department with an abscess on the dorsum of the left foot. After urgent drainage with tendon exposure, he started specific antibiotic therapy and underwent tibial vessels angioplasty. After infection healing cord blood platelet gel was applied, accelerating the healing process, with injection of its liquid part into the exposed tendons, thus retaining the vital functions of the tendons.


Subject(s)
COVID-19 , Diabetes Mellitus , Diabetic Foot , Amputation , Blood Platelets , Diabetic Foot/therapy , Humans , Ischemia , Male , Pandemics , SARS-CoV-2 , Tendons , Treatment Outcome
9.
Int J Environ Res Public Health ; 18(15)2021 07 29.
Article in English | MEDLINE | ID: covidwho-1346483

ABSTRACT

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 , Walking
10.
J Wound Care ; 30(Sup7): S18-S27, 2021 Jul 01.
Article in English | MEDLINE | ID: covidwho-1310247

ABSTRACT

AIM: The purpose of this clinical trial was to evaluate the safety and efficacy of a fetal bovine acellular dermal matrix (FBADM) plus standard of care (SOC) for treating hard-to-heal diabetic foot ulcers (DFUs). METHOD: A prospective, multi-centre, randomised controlled trial was carried out. The study included a 2-week run-in period, a 12-week treatment phase and a 4-week follow-up phase. The primary endpoint was complete wound closure at 12 weeks. RESULTS: Twenty-one US sites enrolled and randomised 226 patients with hard-to-heal DFUs. The study was terminated early due to the COVID-19 pandemic, which led to a modified intent-to-treat (mITT) population of 207 patients, with 103 in the FBADM group and 104 in the SOC group. Of these participants, 161 completed the study per protocol (mPP population), with 79 receiving FBADM, and 82 without. At the first analysis point, patients treated with FBADM were found to be significantly more likely to achieve complete wound closure compared with SOC alone (mITT: 45.6% versus 27.9% p=0.008; mPP: 59.5% versus 35.6% p=0.002). The difference in outcome yielded an odds ratio of 2.2 (95% confidence interval (CI): 1.2, 3.9; p=0.008). Median time to closure within 12 weeks was 43 days for the FBADM group compared to 57 days for the SOC group (p=0.36). The median number of applications of FBADM to achieve closure was one. Adverse events were similar between groups and no product-related serious adverse events occurred. CONCLUSIONS: These results indicate that in many cases a single application of FBADM in conjunction with SOC offers a safe, faster and more effective treatment of DFUs than SOC alone.


Subject(s)
Acellular Dermis , COVID-19 , Diabetes Mellitus , Diabetic Foot , Animals , Cattle , Diabetic Foot/surgery , Humans , Pandemics , Prospective Studies , SARS-CoV-2 , Treatment Outcome
11.
PLoS One ; 16(7): e0253434, 2021.
Article in English | MEDLINE | ID: covidwho-1290917

ABSTRACT

BACKGROUND: Descriptive analyses of 2009-2016 were performed using the data of the Universal Coverage Scheme (UCS) which covers nearly 70 percent of the Thai population. The analyses described the time and geographical trends of nationwide admission rates of type 2 diabetes mellitus (T2DM) and its complications, including chronic kidney disease (CKD), myocardial infarction, cerebrovascular diseases, retinopathy, cataract, and diabetic foot amputation. METHODS AND FINDINGS: The database of T2DM patients aged 15-100 years who were admitted between 2009 and 2016 under the UCS and that of the UCS population were retrieved for the analyses. The admitted cases of T2DM were extracted from the database using disease codes of principal and secondary diagnoses defined by the International Classification of Diseases 9th and 10th Revisions. The T2DM admission rates in 2009-2016 were the number of admissions divided by the number of the UCS population. The standardized admission rates (SARs)were further estimated in contrast to the expected number of admissions considering age and sex composition of the UCS population in each region. A linearly increased trend was found in T2DM admission rates from 2009 to 2016. Female admission rates were persistently higher than that of males. In 2016, an increase in the T2DM admission rates was observed among the older ages relative to that in 2009. Although the SARs of T2DM were generally higher in Bangkok and central regions in 2009, except that with CKD and foot amputation which had higher trends in northeastern regions, the geographical inequalities were fairly reduced by 2016. CONCLUSION: Admission rates of T2DM and its major complications increased in Thailand from 2009 to 2016. Although the overall geographical inequalities in the SARs of T2DM were reduced in the country, further efforts are required to improve the health system and policies focusing on risk factors and regions to manage the increasing T2DM.


Subject(s)
Diabetes Complications/therapy , Diabetes Mellitus, Type 2/therapy , Patient Admission/trends , Universal Health Insurance/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Cataract/complications , Cataract/therapy , Diabetes Mellitus, Type 2/etiology , Diabetic Foot/complications , Diabetic Foot/surgery , Diabetic Retinopathy/complications , Diabetic Retinopathy/therapy , Female , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/therapy , Patient Admission/statistics & numerical data , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Thailand , Young Adult
13.
Br J Community Nurs ; 26(Sup6): S6-S9, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1262692

ABSTRACT

Community nurses face numerous challenges in both diagnosing and effectively treating their patients. The diabetic patient has complex needs requiring a holistic approach. With a reported increase in diabetic patients, and a possible decline in some routine screening following Covid-19 pandemic, complications in diabetic patients are likely to rise. It is estimated that 25% of diabetic patients will develop a diabetic foot ulcer (DFU), with a reported 43% of DFU already infected at first presentation to a health professional. NICE categorise the level of infection in DFU based on standardised assessments such as SINBAD. A high categorised DFU has the possibility of osteomyelitis. It is imperative that osteomyelitis is treated immediately to achieve positive outcomes, benefitting the patients' health and wellbeing in addition to reducing the financial implications to the NHS.


Subject(s)
COVID-19 , Community Health Nursing/standards , Diabetic Foot/nursing , Holistic Nursing/standards , Nurse's Role , Osteomyelitis/nursing , Practice Guidelines as Topic , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
14.
PLoS One ; 16(5): e0251143, 2021.
Article in English | MEDLINE | ID: covidwho-1218425

ABSTRACT

AIMS: Limb and patient outcomes in people with diabetic foot complications including diabetic foot ulcer (DFU) provided virtual triage and personalized video consultations during COVID-19 pandemic are not known. METHODS: Patients with foot complications attending the diabetic foot clinic prior to lockdown who sought teleconsultations during COVID-19 lockdown underwent virtual triage to include clinical history, visual inspection of feet, domiciliary wound care (community nurse assisted dressings) and offloading instructions. The subsequent ulcer, limb and mortality outcomes during the following 24 weeks of COVID-19 lockdown (April-September 2020, group 1) were assessed and compared with those who attended foot clinic during the same period in 2019 (April-September, group 2). RESULTS: Group 1 included 561 participants with foot complications provided with teleconsultations, median age 57 (51 to 63) years and diabetes duration of 10 (5 to 16) years. Twelve patients with severe DFU were excluded and 549 patients [357 (65%) neuropathic foot, 104 (18.9%) ischemic foot and 88 (16%) chronic Charcot foot with deformities] were evaluated. There were 227 (41.3%) participants with active DFU at start of lockdown, 32 (5.8%) with new onset ulcer during lockdown (47.1%) and 290 patients without ulcers. Group 2 included 650 participants; active foot ulcer was present in 366 patients. Wound closed or reduced in area in 78.4% of participants of group 1 compared to 76.0% (p = 0.318) in group 2. Fourteen (5.4%) patients required amputations [3 major and 11 minor] in group 1 during the study period compared to 6.8% in group 2 (p = 0.191). Twenty-one (3.8%) and 28 (4.3%) patients died (p = 0.532) during 24 weeks of follow up in group 1 and 2, respectively. CONCLUSIONS: Targeted foot-care service through virtual triage and teleconsultations during COVID-19 pandemic for people with foot complications have similar ulcer and limb outcomes compared to face-to-face foot care delivery.


Subject(s)
Diabetic Foot/therapy , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Diabetes Mellitus/epidemiology , Diabetic Foot/epidemiology , Humans , Middle Aged , Prospective Studies , Retrospective Studies , Treatment Outcome , Triage
15.
Adv Wound Care (New Rochelle) ; 10(5): 281-292, 2021 05.
Article in English | MEDLINE | ID: covidwho-1207238

ABSTRACT

Significance: Chronic wounds impact the quality of life (QoL) of nearly 2.5% of the total population in the United States and the management of wounds has a significant economic impact on health care. Given the aging population, the continued threat of diabetes and obesity worldwide, and the persistent problem of infection, it is expected that chronic wounds will continue to be a substantial clinical, social, and economic challenge. In 2020, the coronavirus disease (COVID) pandemic dramatically disrupted health care worldwide, including wound care. A chronic nonhealing wound (CNHW) is typically correlated with comorbidities such as diabetes, vascular deficits, hypertension, and chronic kidney disease. These risk factors make persons with CNHW at high risk for severe, sometimes lethal outcomes if infected with severe acute respiratory syndrome coronavirus 2 (pathogen causing COVID-19). The COVID-19 pandemic has impacted several aspects of the wound care continuum, including compliance with wound care visits, prompting alternative approaches (use of telemedicine and creation of videos to help with wound dressing changes among others), and encouraging a do-it-yourself wound dressing protocol and use of homemade remedies/substitutions. Recent Advances: There is a developing interest in understanding how the social determinants of health impact the QoL and outcomes of wound care patients. Furthermore, addressing wound care in the light of the COVID-19 pandemic has highlighted the importance of telemedicine options in the continuum of care. Future Directions: The economic, clinical, and social impact of wounds continues to rise and requires appropriate investment and a structured approach to wound care, education, and related research.


Subject(s)
Leg Ulcer/epidemiology , Pressure Ulcer/epidemiology , Wound Infection/epidemiology , Wounds and Injuries/epidemiology , Acute Disease , Bandages , COVID-19 , Chronic Disease , Delivery of Health Care , Diabetes Mellitus/epidemiology , Diabetic Foot/economics , Diabetic Foot/epidemiology , Diabetic Foot/therapy , Education, Medical , Education, Nursing , Foot Ulcer/economics , Foot Ulcer/epidemiology , Foot Ulcer/therapy , Humans , Leg Ulcer/economics , Leg Ulcer/therapy , Obesity/epidemiology , Overweight/epidemiology , Patient Education as Topic , Pressure Ulcer/economics , Pressure Ulcer/therapy , SARS-CoV-2 , Self Care , Social Determinants of Health , Telemedicine , United States/epidemiology , Varicose Ulcer/economics , Varicose Ulcer/epidemiology , Varicose Ulcer/therapy , Wound Infection/economics , Wound Infection/microbiology , Wound Infection/therapy , Wounds and Injuries/economics , Wounds and Injuries/therapy
16.
Medicina (Kaunas) ; 57(4)2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1187001

ABSTRACT

About 422 million people worldwide have diabetes and approximately one-third of them have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare ecosystem, which is centered on the treatment of established foot disease, often fails to adequately control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions. Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority from siloed hospital treatments to innovative integrated community prevention is now critical to address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable and digital health technologies provide a means to timely monitor major risk factors associated with diabetic foot ulcer, empower patients in self-care, and effectively deliver the remote monitoring and multi-disciplinary prevention needed for those at-risk people and address the health care access disadvantage that people living in remote areas. This narrative review paper summarizes some of the latest innovations in three specific areas, including technologies supporting triaging high-risk patients, technologies supporting care in place, and technologies empowering self-care. While many of these technologies are still in infancy, we anticipate that in response to the Coronavirus Disease 2019 pandemic and current unmet needs to decentralize care for people with foot disease, we will see a new wave of innovations in the area of digital health, smart wearables, telehealth technologies, and "hospital-at-home" care delivery model. These technologies will be quickly adopted at scale to improve remote management of diabetic foot ulcers, smartly triaging those who need to be seen in outpatient or inpatient clinics, and supporting acute or subacute care at home.


Subject(s)
COVID-19 , Diabetes Mellitus , Diabetic Foot , Amputation , Diabetic Foot/prevention & control , Ecosystem , Humans , SARS-CoV-2
17.
J Wound Care ; 30(Sup4): S42-S52, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1187162

ABSTRACT

OBJECTIVE: Management of chronic wounds remains one of the major challenges for health professionals and patients. An evidence-based decision is important to ensure that patients are receiving the best treatment proven to reduce healing time and improve outcomes, including economic benefits and patients' health-related quality of life (HRQoL). Due to recent restrictions because of the COVID-19 pandemic, including closure of wound care centres within hospitals and a drop in patient volume, chronic wound management needs simple-to-use dressings which are still effective and evidence-based solutions. This systematic review was conducted to identify the clinical evidence available on a sucrose octasulfate dressing (TLC-NOSF, UrgoStart dressing range, Laboratoires Urgo, France) to explore its efficacy in the management of chronic wounds, particularly lower limb ulcers, diabetic foot ulcers and pressure ulcers. METHOD: A literature search of PubMed, Cochrane Library and Google Scholar was conducted based on the PICO model (patient/population, intervention, comparison and outcomes) to retrieve publications of different levels of evidence in order to evaluate outcomes of the use of TLC-NOSF dressings. RESULTS: A total of 21 publications of different levels, ranging from double-blind randomised control trials to case reports, involving over 12,000 patients, were identified through PubMed, with a further eight publications through Google Scholar and two publications through Cochrane Library. A total of seven results were omitted due to the lack of relevance or repetition. CONCLUSION: All the evidence provided suggest that these dressings provide clinicians with an evidence-based option for the management of chronic wounds; that the TLC-NOSF dressings are beneficial in promoting the healing process, reducing healing times, enhancing patients' HRQoL, and in allowing a more cost-effective procedure.


Subject(s)
Bandages, Hydrocolloid , Chronic Disease/therapy , Diabetic Foot/therapy , Pressure Ulcer/therapy , Sucrose/analogs & derivatives , Sucrose/therapeutic use , Wound Healing/physiology , Adult , Aged , Aged, 80 and over , Double-Blind Method , Female , France , Humans , Male , Middle Aged
18.
Adv Skin Wound Care ; 34(5): 1-4, 2021 May 01.
Article in English | MEDLINE | ID: covidwho-1183033

ABSTRACT

ABSTRACT: In this case report, the treatment of a patient with a diabetic foot ulcer on his left foot was interrupted by the novel coronavirus 2019 pandemic lockdown in India. The author guided the patient via telephone and online services. Based on the history given by the patient, the lesion started as blistering from improperly fitted footwear that then evolved into multiple infected ulcerations on the dorsal surface of the great toe (osteomyelitis with septic arthritis of the joint). Based on a radiograph and other photographs of the foot lesions, the author prescribed amoxicillin/clavulanic acid in combination with linezolid for 2 weeks. Further, the author guided the patient to dress the wound at home using a medical-grade honey-based product. With no option for an outpatient visit, the author guided the patient to use a plastic ruler and place it below the toe during each dressing. Healing (complete epithelialization) was achieved within 4 weeks.


Subject(s)
Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Diabetic Foot/therapy , Honey , Linezolid/therapeutic use , Amputation , Bandages , COVID-19 , Humans , India , Male , Shoes , Telemedicine , Wound Healing
19.
Diabetes Res Clin Pract ; 175: 108797, 2021 May.
Article in English | MEDLINE | ID: covidwho-1179400

ABSTRACT

AIM: To investigate the rate of antibiotic resistance and its main risk factors in a population of patients with diabetic foot infection (DFI) during the COVID-19 pandemic, in comparison with the population of 2019. METHODS: Two hundred and twenty-five patients with DFI were admitted in a tertiary care center from January 2019 to December 2020. Antibiotic resistance was evaluated by microbiological examination of soft tissues' or bone's biopsy. RESULTS: Compared with 2019 group (n = 105), 2020 group (n = 120) had a significantly higher prevalence of antibiotic resistance [2019 vs 2020, 36% vs 63%, P <0.001] and more often was admitted with recent or current antibiotic therapy (18% vs 52%, P <0.001), which was frequently self-administered (5% vs 30%, P = 0.032). The risk of antibiotic resistance was also higher in 2020 group [OR 95% CI, 2.90 (1.68 to 4.99)]. Prior hospitalization, antibiotic self-administration and antibiotic prescription by general practitioners resulted as independent predictors of antibiotic resistance. CONCLUSIONS: In a population of people with DFI admitted in a tertiary care center during the COVID-19 pandemic the prevalence of antibiotic resistance was higher than 2019. Previous hospitalization, antibiotic self-administration /prescription by general practitioners were related to higher risk of antibiotic resistant infections.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Diabetic Foot/drug therapy , Aged , COVID-19 , Diabetic Foot/epidemiology , Drug Resistance, Microbial , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Tertiary Care Centers
20.
Diabet Med ; 38(7): e14577, 2021 07.
Article in English | MEDLINE | ID: covidwho-1165904

ABSTRACT

AIMS/HYPOTHESIS: The aim of this study was to examine the impact of the COVID-19 epidemic on the hospitalization rates for diabetic foot ulcer (DFU), osteomyelitis and lower limb revascularization procedure in people with DFU. METHODS: This nationwide retrospective cohort study included hospital data on all people hospitalized in France for diabetes in weeks 2-43 in 2020, including the COVID-19 lockdown period, compared to same period in 2019. RESULTS: The number of hospitalizations for DFU decreased significantly in weeks 12-19 (during the lockdown) (p < 10-4 ). Hospitalization for foot osteomyelitis also decreased significantly in weeks 12-19 (p < 10-4 ). The trend was the same for lower limb amputations and revascularizations associated with DFU or amputation. CONCLUSIONS/INTERPRETATION: The marked drop in hospitalization rates for DFU, osteomyelitis and lower limb revascularization procedures in people with DFU observed in France during the lockdown period suggests that COVID-19 was a barrier to DFU care, and may illustrate the combined deleterious effects of hospital overload and changes in health-related behaviour.


Subject(s)
COVID-19/epidemiology , Diabetic Foot/epidemiology , Diabetic Foot/therapy , Hospitalization/statistics & numerical data , Quarantine , Aged , Aged, 80 and over , Amputation/statistics & numerical data , Amputation/trends , COVID-19/prevention & control , Cohort Studies , Communicable Disease Control/methods , Epidemics , Female , France/epidemiology , History, 21st Century , Hospitalization/trends , Humans , Lower Extremity/surgery , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/physiology
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