ABSTRACT
Studies have been conducted to evaluate the efficacy of dehydrated human amnion chorion membrane (dHACM) in treating recalcitrant diabetic foot ulcers. A literature search was performed to review the data collected from the use of dHACM allografts. Two products were explicitly named in these publications, EpiFix and AmnioBand Membrane. Relevant results included the healing rate, number of wounds healed, and number of grafts used. Data had supported the potential of lowering the overall cost to manage a wound despite a relatively higher cost per dressing. However, discrepancy was observed in the rate of healing between several of the studies. Nonetheless, dHACM had demonstrated improvement in healing of recalcitrant diabetic foot ulcers compared to standard of care alone. These results provide grounds for more inclusive research on dHACM in the future.
Subject(s)
Diabetes Mellitus , Diabetic Foot , Allografts , Amnion , Chorion , Diabetic Foot/therapy , Humans , Treatment OutcomeABSTRACT
The Board of Directors of the American Board of Podiatric Medicine approved the following position statement regarding hospital and surgical privileges for doctors of podiatric medicine on February 27, 2019. This statement is based on federal law, Centers for Medicare and Medicaid Services Conditions of Participation and Standards of the Joint Commission, and takes into account the current education, training, and experience of podiatrists to recommend best practices for hospital credentialing and privileging.
Subject(s)
Certification/standards , Medical Staff Privileges/standards , Podiatry/standards , Centers for Medicare and Medicaid Services, U.S. , Certification/legislation & jurisprudence , Organizational Policy , Podiatry/education , Specialty Boards , United StatesABSTRACT
Hyperbaric oxygen therapy (HBOT) is a useful tool for many conditions within the scope of practice of a Doctor of Podiatric Medicine (DPM). More wound-care clinics are adding HBOT as a service line. The increasing prevalence of DPMs operating inside of these wound-care clinics has raised questions about the licensure and privileging of DPMs to supervise HBOT. This document reviews the safety of outpatient HBOT and provides guidelines for hospitals to credential DPMs to supervise treatments.
Subject(s)
Credentialing/standards , Hyperbaric Oxygenation/standards , Podiatry/organization & administration , Practice Guidelines as Topic/standards , Wounds and Injuries/therapy , Humans , United StatesABSTRACT
Percent area reduction (PAR) after 4 weeks of diabetic foot ulcer (DFU) treatment has been suggested as a clinical monitoring parameter to distinguish DFUs that will heal within 12 weeks from those that will not despite standard wound care. The purpose of this post-hoc analysis of control DFU treatment outcomes from two published, randomized, controlled studies was to assess the relationship between PAR during early standard wound care and ulcer closure by week 12. The proportion of DFUs healed after 12 weeks was 57% (39 out of 69; 95% confidence interval [CI], 44% to 68%) in study A and 52% (38 out of 73; 95% CI, 40% to 64%) in study B for wounds with > or = 50% PAR by week 4 and 5% (three out of 64; 95% CI, 1% to 13%) and 2% (one out of 44; 95% CI, 0.1% to 12%), respectively, for DFUs with < 50% PAR at week 4. Regardless of baseline size category, DFUs with < 50% PAR at 4 weeks were less likely to heal by 12 weeks than DFUs with > or = 50% PAR (P < or = 0.001). Using pooled data, PAR at weeks 1 to 3 also varied between ulcers that did and did not heal after 12 weeks but sensitivity and specificity was highest on week 4. These findings confirm that percent reduction in wound size is an early predictor of treatment outcome and that protocols of care should be re-evaluated if > or = 50% PAR is not achieved. Studies to assess DFU healing before and after 4 weeks of standard wound care are needed to further refine these guidelines of care.
Subject(s)
Diabetic Foot/therapy , Wound Healing , Diabetic Foot/physiopathology , HumansABSTRACT
Pigmented villonodular synovitis is nonmalignant and nonmetastasizing, but it is locally destructive and can result in considerable disability through infiltration and involvement of surrounding soft tissues and bone. This article briefly describes the clinical picture of the diffuse form of pigmented villonodular synovitis and reports on two cases involving juxta-articular erosions of the calcaneocuboid joint. Treatment involved substantial curettage of bone and resection of infiltrated intrinsic musculature.
