Patients' behaviour after referral to a wound care clinic for diabetic foot ulcer care: a grounded theory study.

OBJECTIVE: The aim of this study was to construct a grounded theory regarding patients' activity behaviour over time after referral to an outpatient clinic for diabetic foot ulcer (DFU) care. METHOD: A constructivist grounded theory approach was used. Data from observations of and interviews with participants were collected and analysed using the constant comparative method. Based on this, the grounded theory 'Just a bump in the road' was constructed. RESULTS: The cohort included five participants who considered their ulcers as 'Just a bump in the road' in their lives, and four subcategories were embedded in this core category: 'Restricting my freedom'; 'Trusting or doubting the system'; 'Feeling no pain or illness'; and 'Receiving insufficient information'. Together, these categories describe the participants' behaviour and underlying concerns related to daily activities after referral to an outpatient clinic for the care of their DFU. CONCLUSION: The grounded theory 'Just a bump in the road' describes how participants with a DFU viewed their condition as merely a passing phase that would end with them regaining what they considered a normal life. Integrating these results into clinical practice could lead to improved care and a focus shift among health professionals from viewing patients as being defined by their wounds to seeing them as people who live with a wound.

Impact of foot ulcer-related factors on quality of life in patients with diabetes: Prospective observational study.

Quality of life (QOL) may be impacted by foot ulcer-related factors, with prevention of diabetes-related foot ulcers or more effective early healing helping to improve overall patient QOL. This study, which examined the relationship between foot ulcer-related factors and QOL in patients with diabetes, was conducted as a secondary analysis of a prospective observational study entitled: "Factors associated with the discontinuation of wound care specialist clinic visits in patients with diabetic foot ulcers". We investigated EQ-5D-5L, patient characteristics and foot ulcer-related factors of 73 patients with diabetes-related foot ulcers who visited one wound clinic in Indonesia between August 2020 and February 2021. Results showed that the mean health utility was 0.294 ± 0.371. Factors selected for the multiple regression analysis included inflammation/infection of DMIST, first-ever foot ulcer, and size of DMIST. First-ever foot ulcer (ß = 0.309, p = 0.003) and size of DMIST (ß = -0.316, p = 0.015) were significantly associated with the health utility (p < 0.001). Significant improvement in the health utility of 15 patients was observed when the ulcer healed (Wilcoxon signed-rank sum test, p = 0.001). In conclusion, not only ulcer severity but also the first-ever foot ulcer itself affected the QOL in patients with diabetes. These results suggest there will be a greater impact on the QOL of patients who develop diabetes-related foot ulcers for the first time, along with the importance of prevention and early healing, through early infection control and wound size reduction.

Foot self-care behaviour in primary care patients with diabetic foot ulcers: Structural equation modelling of psychological predictors.

Diabetic foot ulcers (DFUs) are one of the most prevalent and costly diabetes complications, associated with diminished quality of life and poor prognosis. Management of DFUs relies heavily on patients' foot self-care behaviour. This study aims to explore psychological determinants of this important behaviour among primary care patients. A total of 186 patients with active DFUs self-reported their illness perception, diabetes distress, self-efficacy, and foot self-care behaviour. Structural equation modelling was performed to examine interrelationships among measured variables. The final model demonstrated satisfactory fit, CFI = 0.933, TLI = 0.913, RMSEA = 0.050, SRMR = 0.073, χ2(95) = 132.256 (p = 0.004), and explained 51.1% of the variance of foot self-care. Illness threat perceptions (i.e., consequence, timeline, identity, concern, and emotion) had a direct positive effect on foot self-care behaviours, but also indirectly decreased foot self-care through increasing diabetes distress. Control perceptions (i.e., personal control, treatment control, and coherence) were not directly associated with foot self-care behaviours, but indirectly improved foot self-care by reducing diabetes distress and increasing foot care confidence. These findings suggest illness perceptions, diabetes distress, and self-care confidence as modifiable predictors to be targeted in self-management interventions for patients with DFUs.

Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach: Exploratory Cross-Sectional Study of Patients' Views on Quality of Care.

PURPOSE: The purpose of this study was to evaluate patients' perception and quality of diabetic foot ulcer (DFU) care delivered by an interdisciplinary team approach (ITA). DESIGN: Exploratory cross-sectional study. SUBJECTS AND SETTING: Twenty patients with a healed plantar DFU were recruited from an interdisciplinary Wound Care clinic of a Canadian University affiliated hospital. Their mean age was 64 years (75% were males [n = 15]), 18 (90%) were living with type 2 diabetes, and 45% (n = 9) had osteomyelitis in the previous year of their enrollment in the study. METHODS: The validated short form of the Quality From the Patient's Perspective questionnaire was used to evaluate quality of care dimensions (medical-technical competence of the caregivers; physical-technical conditions of the care organization; degree of identity-orientation in the attitudes and actions of the caregivers; and sociocultural atmosphere of the care organization). RESULTS: Respondents reported experiencing a high level of quality care with an ITA. All indicators of patient-perceived reality of care delivered were superior or equal related to their subjective importance in all dimensions of quality care (with scores ranging from 3.85 to 4.00 on a 4-Point Likert scale). Patients' satisfaction regarding the ITA was high. CONCLUSIONS: Study findings suggest that an ITA model provided high quality of care for treating DFUs for all quality dimensions judged important for patients.

Needs and preferences regarding a mobile application to support diabetic foot self-care.

OBJECTIVE: To identify the needs and preferences of individuals with type 2 diabetes regarding the functionalities and characteristics for a mobile application to support foot self-care. METHOD: Qualitative research with 16 individuals diagnosed with type 2 diabetes recruited during clinical care at a university hospital in Porto, Portugal. Data were collected through semi-structured interviews between March and June 2022 and analyzed using inductive content analysis. RESULTS: Three categories and nine subcategories were identified. Categories included informational needs, essential functionalities for foot health self-care, and user-relevant experience. The preference for objective, limited data input, flexible, and customizable applications was an important factor influencing technology engagement. CONCLUSION: The research highlighted a preference for customizable and flexible applications, aiding nurses in creating solutions that transform care delivery and enhance the quality of life for individuals living with diabetes.

Patient Perceptions and Experiences With Maggot Debridement Therapy for Managing Chronic Wounds.

PURPOSE: The purpose of this study was to describe patient experiences and satisfaction with use of maggot debridement therapy (MDT) for hard-to-heal wounds. DESIGN: Descriptive, cross-sectional study. SUBJECTS AND SETTING: The sample comprised 60 participants, 60% were male (n = 36). Their mean age was 62.9 (SD = 20) years. Almost half of participants had lower extremity wounds (n = 26; 43.3%), diabetic foot ulcers (n = 18; 30%), and pressure injuries (n = 9; 15%). Most received maggot therapy via biobags (n = 36; 60%). METHODS: Participants completed a questionnaire designed for purposes of the study that queried demographic and pertinent clinical characteristics, current health status including current topical therapies, and duration of their chronic wound. Nine items queried emotional responses prior to MDT, the amount and method of the maggot therapy, discomfort experienced during therapy, and sources of information regarding this treatment. RESULTS: Emotional responses before starting MDT included disgust (n = 30, 50%), anxiety (n = 26, 43.3%), doubts about its effectiveness (n =20, 33.3%), and disbelief (n = 11, 18.3%). Approximately one-third of participants reported feelings of biting, itching, and fear of the maggots. Despite these feelings, a majority (n = 38, 63.3%) indicated that they were pleased with treatment outcome and willing to undergo additional MDT if needed. CONCLUSIONS: While a majority of participants with nonhealing chronic wounds reported negative emotions association with MDT, more than half indicated that they were pleased with the outcome of treatment and willing to undergo repeat treatment if indicated.

Enhancing foot care education and support strategies in adults with type 2 diabetes.

BACKGROUND: People with diabetes are susceptible to serious and disabling foot complications, which increase their morbidity and mortality rates. Examining the perspectives of people with diabetes on their foot care routines could help elucidate their beliefs and offer practical ways to prevent foot problems. PURPOSE: We explored the perspectives of adults with diabetes on their foot care practices to identify and enhance foot care education and support strategies. METHODOLOGY: Using the Zoom platform, 29 adults with diabetes completed a 3-month telehealth educational program, during which interviews were conducted. This article reports the results of thematic content analysis of the qualitative data. Coded participant statements were organized into categories and reexamined to identify emergent themes. RESULTS: Analysis of participants' perceptions revealed four main themes of influences that facilitated and/or hindered their foot care practices. Foot care behaviors were facilitated by patients' personal knowledge of others with diabetes-related foot consequences (theme 1). Foot care practices were hindered by the emotional impact of living with diabetes (theme 2), and the physical, social, and lifestyle limitations associated with foot care (theme 3). Finally, patients noted that interactions with family could be either a facilitator or hindrance to their foot care routines (theme 4). CONCLUSIONS: These findings highlight multiple patient-centered factors related to personal, physical, psychosocial, and cultural influences that affect foot care behaviors. IMPLICATIONS: An understanding of how patients manage diabetes-related foot care can help nurse practitioners enhance foot care education and support strategies in this population.

The Impact of Diabetic Foot Ulcer on Individuals' Lives and Daily Routine: A Qualitative Study Informed by Social Constructivism and Symbolic Interactionism Frameworks.

PURPOSE: The purpose of this study was to explore the impact of diabetic foot ulcer (DFU) on individuals' lives and daily routines. DESIGN: Qualitative design informed by social constructivism and symbolic interactionism frameworks. SUBJECTS AND SETTING: The sample comprised 30 individuals attending a wound care clinic in Southeast Ontario, Canada. Most participants (n = 17) were between the ages of 65 and 92 years, were male (n = 20), married (n = 21), living with their family (n = 23), and had completed high school (n = 26). METHODS: One-to-one semistructured interviews were conducted by the first author until saturation of each emerging theme was achieved. Interviews were audio-recorded and lasted from 45 to 90 minutes. Data collection and analysis occurred simultaneously and included intensive semistructured interviews, field notes, and researcher's journal. RESULTS: Participants with DFUs were found to perceive a "sense of life change," impacting their lives across physical, psychological, and social spheres. They reported 4 key themes indicating that DFUs were (1) limiting their outings; (2) restricting leisure activities; (3) impacting personal and social life; and (4) contributing to emotional fluctuations. CONCLUSION: Sense of life changes resulting from DFUs were associated with participant reporting loss of freedom and enjoyment. These findings underscore the need for holistic support for patients with DFUs that simultaneously address physical, psychological, and social needs and areas of impact.

The validity and reliability of the Diabetic Foot Scale-Short Form (DFS-SF) in the Turkish population: a methodological study.

Background/aim: Diabetic foot ulcers (DFUs) cause decreased quality of life due to prolonged hospital stay, loss of workforce, disabilities, psychological trauma, and increased healthcare costs. This study aims to assess the validity and reliability of the Diabetic Foot Scale-Short Form (DFS-SF) for Turkish-speaking individuals with DFUs. Materials and methods: This was a methodological study conducted with 174 Turkish patients with DFUs from March 2020 to December 2020. Translation-back translation was performed for language equivalence and expert opinions were obtained for content validity. The scale's construct validity was tested with confirmatory factor analysis, exploratory factor analysis, and known-group validity. Cronbach's alpha was used to evaluate internal consistency. Correlation of the DFS-SF with the SF-36 was used to test criterion validity. The scale was then revised according to the TRIPOD checklist. Results: The content validity index value was 0.93 and Cronbach's alpha ranged from 0.93 to 0.97. The scale maintained its six-factor structure and the factor loadings ranged from 0.52 to 0.86. The fit indices of the model revealed good validity. The correlations (r = 0.43-0.76, p < 0.001) and known-group comparisons supported the construct validity. Conclusion: The Turkish version of the DFS-SF is a reliable tool for measuring the quality of life of people suffering from DFUs.

CHRONIC COMPLICATIONS OF DIABETES AND QUALITY OF LIFE.

The course of diabetes is marked by the development of chronic complications that, in addition to affecting health, also affect the quality of life of patients. The purpose of this study was to compare the quality of life of patients with type 2 diabetes based on their chronic complications. The study, which was conducted from March 2019 until March 2020, included 382 diabetic patients, specific data from medical records, and the application of the World Health Organization Quality of Life-Brief questionnaire. There were more men than women included in the study, with the majority of respondents belonging to the age group of 61 to 70 years. In the quality-of-life assessment, the mean value of physical functioning was 57.14 (42.86-71.43), psychological functioning was 66.67 (54.17-79.17), social functioning 66.67 (50.00-75.00), and environmental functioning was 68.75 (50.00-75.00). The domains of social functioning were lowest in patients with diabetic retinopathy and neuropathy, while the physical functioning domains were rated lowest in patients with diabetic nephropathy, diabetic foot ulcer, and multiple chronic complications. All domains were rated lowest by patients with multiple complications and highest by those without any complications. In conclusion, differences in the assessment of quality of life of diabetic patients depend on the type of chronic complication.

Psychological and Cognitive Barriers to Diabetes-Related Foot Complication Treatment: Clinicians' Perspectives.

This study investigated clinicians' perspectives about cognitive functioning and mental health in individuals with diabetes-related foot complications (DRFCs), and how these impact the clinicians' treatment of the patients' conditions. Psychological and cognitive impairments may be more pronounced in individuals with DRFCs compared with the general diabetes mellitus population. Understanding these factors will identify potential barriers to DRFC treatment adherence and effective disease self-management. Fourteen multidisciplinary clinicians (Meanage = 37.86 years; standard deviation = 9.26; range = 27-51) were recruited from a metropolitan hospital diabetic foot unit. Semistructured interviews were conducted with each clinician, followed by the completion of a brief quantitative questionnaire. Interview data were analyzed thematically. Six themes that encompassed factors affecting DRFC treatment were identified: (1) psychological and cognitive characteristics; (2) the person in the environment; (3) illness and self-identity; (4) burden of chronic disease; (5) engaging with treatment; and (6) the clinician and health system response. Quantitative questionnaire results coincided with qualitative findings, with endorsement of global psychological and cognitive impairment in individuals with DRFC, which considerably affected their ability to engage in treatment. From the perspectives of clinicians working with patients with DRFCs, psychological, cognitive, and social factors have a considerable influence on DRFC treatment and self-management. Further investigation of these factors and their interrelationships is necessary to enhance treatment adherence in individuals with DRFCs.

Acceptance of illness, quality of life and nutritional status of patients after lower limb amputation due to diabetes mellitus.

INTRODUCTION: Diabetes mellitus is one of the most common chronic diseases with a high number of sufferers worldwide. Diabetic neuropathy and diabetic angiopathy lead to serious infectious complications which are very difficult to combat and may finally lead to the amputation of a lower limb. The aim of the study was to evaluate the quality of life, the level of acceptance of the illness and the nutritional status of patients after lower limb amputation due to diabetes. METHODS: Ninety-nine patients (23 men and 76 women) were enrolled into the study. They had all undergone lower limb amputation due to diabetic foot and were treated in the Department of General and Oncological Surgery. The following questionnaires were used: the WHO Quality of Life-BREF (WHOQOL-BREF), the Mini Nutritional Assessment (MNA), the Acceptance of Illness Scale (AIS) and the anonymous specific socio-demographic characteristics questionnaire. RESULTS: The diabetes-related amputees were revealed to have a higher QoL within the social domain (mean score 64.48), an intermediate QoL - within the environmental domain (mean score 63.04) and the mental domain (mean score 59.61), and a lower QoL - within physical (somatic) domain (mean score 54.69). There was no statistical correlation between genders or between all the domains of QoL (P > 0.05). The mean MNA score was 22.66, which means that patients were at risk of malnutrition. There were statistical differences between women and men as regards nutritional status (P = 0.034). The mean AIS score was 27.65 (27.09 women and 29.48 men), which means that the respondents accept their disease. There was no statistical correlation between gender and the acceptance of the disease (P = 0.288). There was not statistical correlation between age and QoL (P > 0.05). There were statistical differences between age and nutritional status (P < 0.05), and between age and acceptance of the illness (P = 0.044). CONCLUSIONS: The better the quality of life was in all the domains, the better the level of acceptance of illness was. The less malnourished the patient was, the better their quality of life was in all the domains.

Diabetic foot social representations about the experiences of people with diabetes mellitus / Pie diabético: representaciones sociales sobre la experiencia de personas con diabetes mellitus / Pé diabético: representações sociais sobre as vivências das pessoas com diabetes mellitus

ABSTRACT Objective: to understand the social representations about the experiences of people with diabetic foot. Method: a qualitative study, based on the Theory of Social Representations, carried out with 28 participants, in reference services for the treatment of diabetic foot in São Luís, Maranhão, Brazil, from February to May 2019. Data collection took place through semi-structured interviews, a script to characterize the sociodemographic and clinical profile and a field diary. Content analysis was applied with the support of a qualitative data analysis software for categorization. Results: the results made it possible to identify two categories: experiencing diabetic foot, with the respective subcategories, and social responses to diabetic foot. The first category includes the following subcategories: cognitive aspects, psycho-affective aspects, social aspects and morality. The social representations of diabetic foot were based on a painful daily experience, with reference to functional loss, dependence on others and difficulty performing activities that were previously usual. Conclusion: the study made it possible to assert that diabetic foot is an object of social representation, showing how people build, connect and apply knowledge. The research constitutes a support tool for the care of people with diabetic foot, as it assists in the planning of interventions with impacts on the development of representations that generate positive health behaviors, from the perspective of foot self-monitoring.

RESUMEN Objetivo: comprender las representaciones sociales sobre la experiencia de personas que padecen pie diabético. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 28 participantes, en servicios de referencia en tratamiento del pie diabético, en São Luís, Maranhão, Brasil, de febrero a mayo de 2019. La recolección de datos se realizó a través de entrevistas semiestructuradas, guía para caracterizar el perfil sociodemográfico y clínico y diario de campo. El análisis de contenido se llevó a cabo con el soporte de un software de análisis de datos cualitativos para la categorización. Resultados: los resultados permitieron identificar dos categorías: la experiencia de vivir con pie diabético, con sus respectivas subcategorías, y respuestas sociales al pie diabético. En la primera categoría, se encuentran las subcategorías: Aspectos cognitivos, Aspectos psicoafectivos, Aspectos sociales y moralidad. Las representaciones sociales del pie diabético se basaron en una experiencia cotidiana dolorosa, con referencia a la pérdida funcional, la dependencia de los demás y la dificultad para realizar actividades que antes eran habituales. Conclusión: el estudio permitió afirmar que el pie diabético es un objeto de representación social y demuestra cómo las personas construyen, conectan y aplican conocimientos. La investigación se constituye en herramienta de apoyo para el cuidado de personas con pie diabético, puesto que contribuye en la planificación de intervenciones que impacten en el desarrollo de representaciones que generen conductas positivas de salud, desde la perspectiva del autocuidado de los pies.

RESUMO Objetivo: compreender as representações sociais sobre as vivências das pessoas com a condição de pé diabético. Método: estudo qualitativo, fundamentado na Teoria das Representações Sociais, realizado com 28 participantes, em serviços de referência no tratamento de pé diabético, em São Luís, Maranhão, Brasil, de fevereiro a maio de 2019. A coleta dos dados ocorreu por meio de entrevistas semiestruturadas, roteiro para caracterização do perfil sociodemográfico e clínico e diário de campo. Aplicou-se análise de conteúdo com suporte do software de análise qualitativa de dados para categorização. Resultados: os resultados possibilitaram identificar duas categorias: vivenciando o pé diabético, com as respectivas subcategorias, e respostas sociais ante o pé diabético. Na primeira categoria, têm-se as subcategorias: aspectos cognitivos, aspectos psicoafetivos, aspectos sociais e moralidade. As representações sociais do pé diabético se sustentaram em vivência cotidiana penosa, com referência à perda funcional, dependência de terceiros e dificuldade de realizar atividades antes habituais. Conclusão: o estudo possibilitou afirmar que o pé diabético é um objeto de representação social, demonstrando o modo como as pessoas constroem, conectam e aplicam conhecimentos. A investigação constitui ferramenta de apoio ao cuidado da pessoa com pé diabético, por auxiliar no planejamento de intervenções com impactos na elaboração de representações que gerem comportamentos positivos em saúde, na perspectiva da autovigilância dos pés.

Calidad de vida y cicatrización en los pacientes con úlceras de pie diabético en el ámbito latinoamericano / Healing and quality of life and healing in patients with diabetic foot ulcers in the Latin American area

Introducción: Las úlceras del pie diabético (UPD) son una complicación común de la diabetes, y no solo un importante factor de mortalidad, e influyen negativamente en la calidad de vida de las personas con diabetes. Objetivos: Establecer la relación entre la evolución de la cicatrización de las UPD mediante la escala RESVECH 2.0 y la calidad de vida de los pacientes con UPD a partir de la escala Diabetic Foot Ulcer Scale (DFS-SF) en distintos centros de salud de países latinoamericanos. Metodología: Estudio observacional prospectivo longitudinal de medidas repetidas de una cohorte de pacientes con UPD. Se analizó el impacto que las UPD y su tratamiento producen sobre la calidad de vida relacionada a la salud (CVRS) mediante la escala DFS-SF y la relación entre la cicatrización (escala RESVECH 2.0) en el contexto latinoamericano (Argentina, México, Perú, Uruguay). Resultados: La puntuación global para los distintos momentos del estudio mostró un incremento en la CVRS desde el inicio hasta las 8 semanas. Las variables que más influyeron fueron: el tipo de país, las características del cuidador y el tratamiento de la diabetes en los distintos momentos del estudio. En cuanto a la CVRS y el proceso de cicatrización, los resultados muestran que existe correlación entre ambas variables (p < 0,0001) en los tres periodos del estudio. Conclusiones: Existe asociación entre la CVRS de los pacientes con UPD, según el tipo de país, el nivel de estudios y el tratamiento de la diabetes en los tres momentos del estudio. El tipo de movilidad física, las características del cuidador y la presencia de amputación son los factores que más influyeron en la cicatrización de los pacientes con UPD. La mejora en la cicatrización influye en la calidad de vida de los pacientes con UPD (AU)

Introduction: Diabetic foot ulcers (UPD, in spanish) are a common complication of diabetes, and not just a major mortality factor, and negatively influence the quality of life of people with diabetes. Objectives: To establish the relationship between the evolution of UPD healing using the RESVECH 2.0 scale and the quality of life of patients with UPD from the Diabetic Foot Ulcer Scale DFS-SF in different health centers in Latin American countries. methodology: Longitudinal prospective observational study of repeated measures of a cohort of patients with UPD. The impact that UPDs and their treatment produce on health-related quality of life (CVRS, in spanish) was analyzed using the DFS-SF Scale and the relationship between healing (Resvech 2.0 scale) in the Latin American context (Argentina, Mexico, Peru, Uruguay). Results: The global score for the different moments of the study showed an increase in CVRS from baseline to 8 weeks. The variables that most influenced were: the type of country, the characteristics of the caregiver and the treatment of diabetes at the different moments of the study. Regarding CVRS and the healing process, the results show that there is a correlation between both variables p <0.0001 in the three periods of the study. Conclusions: There is an association between CVRS of patients with UPD, according to the type of country, the level of education and the treatment of diabetes in the three moments of the study. The type of physical mobility, the characteristics caregiver and the presence of amputation are the factors that most influenced the healing of patients with UPD. The improvement in Scarring influences the quality of life of patients with UPD (AU)

A fact-finding survey on self-efficacy of foot care behaviour in patients with diabetes: Analysis using the Diabetes Study from the Center of Tokyo Women's Medical University 2017 (DIACET 2017).

Aim: We aimed to determine the association between self-efficacy of foot care behaviour and chronic complications in Japanese patients with diabetes. Methods: We conducted a cross-sectional study based on a questionnaire survey of 4571 patients with type 1 and type 2 diabetes who had (a) given consent to participate in the Diabetes Study from the Center of Tokyo Women's Medical University: DIACET 2017, and (b) completed all the questions of the Japanese Version of Foot Care Confidence Scale (J-FCCS), consisting of 12 statements. Results: A greater proportion of respondents answered that they were not confident in determining the condition of corns and/or calluses and the condition of toenails. The J-FCCS total scores of the patients with retinopathy (p <.001) and numbness or pain in the feet (p <.001) were significantly lower than those of the patients without these complications. In both the multiple regression analysis and logistic regression analysis, lower J-FCCS was significantly associated with retinopathy and numbness or pain in the feet. Conclusion: Foot care education that emphasizes a psychological approach in improving confidence associated with foot self-care is important for patients with advanced complications of diabetes.

Knowledge and practice of diabetic foot care - A scoping review.

BACKGROUND AND AIMS: This review aims to systematically map global evidence on foot-care knowledge and practices in relation to diabetes mellitus (DM) and identify areas that need further research. METHODS: Database searches were undertaken using Google Scholar, Medline (PubMed), Academic Search Complete (EBSCOhost), and Medline (EBSCOhost). Studies were initially sought by title and focused on knowledge of diabetic foot ulcer burden. The framework by Arksey and O'Malley and the PRISMA-SCR guidelines were used to guide the methodology. The themes explored were principles of foot-care knowledge and practice and these were reported using content analysis. The mixed-methods appraisal tool (MMAT) was employed to appraise the quality of the primary studies. RESULTS: Fifty-eight studies published between 2008 and 2018 met the inclusion criteria. Participants in various studies had varying degrees of foot-care knowledge and practice, including foot inspection, foot hygiene, glycaemic control, and foot protection. Many people had knowledge of the various aspects of foot care but fewer practiced proper foot care. The MMAT showed the majority of the articles to be of high quality. CONCLUSIONS: Level of foot-care knowledge and practice varied in the studies. A need for intervention on foot care was highlighted.

Anxiety, depression and their associated risk factors among patients with diabetic foot ulcer: A two center cross-sectional study in Jordan and Saudi Arabia.

BACKGROUND AND AIMS: To determine and analyze the factors related to anxiety and depression in patients having diabetic foot ulcer (DFU). METHODS: This two-center, cross-sectional study was conducted among 250 patients with DFU, who were receiving treatment in the outpatient diabetes foot care clinic at Prince Sultan Military Medical City, Saudi Arabia and National Center for Diabetes, Endocrinology and Genetics, Jordan. Employing the Hospital Anxiety and Depression Scale (HADS), the anxiety and depression levels of the study population were measured. The demographic variables were also recorded. RESULTS: Females displayed significantly higher anxiety (p = 0.032) and depression levels (p = 0.043); and those who were unmarried showed higher anxiety (p = 0.042). School educated patients showed reduced degrees of anxiety (p = 0.023) and depression (p = 0.003) and college educated showed reduced anxiety (p = 0.047) compared to uneducated. Compared to patients on treatment with diet, a significant decline was found in depression (p = 0.034) levels among orally treated patients. Compared to patients on oral medication, patients with oral and insulin treatments revealed higher depression (p = 0.026). Higher-income patients showed a significant decline for anxiety (p = 0.004). Patients who were past smokers had higher anxiety (p = 0.046) than current and never had been smokers. Higher anxiety (p = 0.017) was observed in patients having higher HbA1c levels, similarly, patients with three diabetes-related complications showed higher levels of anxiety (p = 0.001) and depression (p = 0.001). CONCLUSION: Female gender, lower education levels, patients on oral and insulin treatments, low income, high HbA1c levels and patients experiencing a higher number of diabetes-related complications showed either higher anxiety or depression levels.

I fear COVID but diabetic foot (DF) is worse: a survey on patients' perception of a telemedicine service for DF during lockdown.

AIMS: To evaluate the patients' perceptions of telemedicine visits during COVID-19 lockdown and their level of anxiety about COVID and diabetic foot (DF). METHODS: In May 2020, we contacted by phone all the patients who underwent in March and April to remote monitoring visits for DF during the lockdown for COVID-19, with a structured interview, focusing on their perceptions about telemedicine service for DF and on the anxiety toward COVID and DF. RESULTS: We analyzed 257 remote monitoring visits in 211 patients. Two hundred and six patients answered the follow-up interview; 177 patients (85.9%) remembered the monitoring visit, 140 (67.9%) the health care professional and 181 patients (87.9%) the reason of contact; 169 patients were alone during the visit, 37 with a relative. Patients judged useful both the monitoring during pandemic (4.35 ± 0.28 on a maximum of five) and the possibility to continue after the lockdown (4.34 ± 0.23 on a maximum of five). Eventually, we observed that DF patients were more worried by DF than by COVID on a scale from 0 (not fear at all) to 5 (terrified) (4.79 ± 0.05 vs. 3.27 ± 1.03, p < 0.05). This difference was higher in previously ulcerated patients (4.84 ± 0.03 vs. 3.03 ± 1.13, p < 0.05) and even more in amputees (4.93 ± 0.03 vs. 2.73 ± 1.21, p < 0.05). CONCLUSIONS: DF patients appreciated televisits during lockdown and the continuation of this service after its end. In this context DF prevails on COVID in the worries of patients, especially if they are recurrent ones.

Self care practices and psychological distress among diabetic patients in Manipur during COVID-19: A scenario from the North East.

BACKGROUND AND AIM: Uncontrolled diabetes has emerged as one of the major risk factors for mortality in patients with coronavirus disease (COVID-19). Physical inactivity, alterations in dietary habits, and inability to seek guidance from the physician are some of the contributing factors. This study aims to assess the self-care practices and psychological distress during the pandemic among diabetic patients visiting the institute's out patient department. METHOD: A convenient sampling method was used to recruit subjects from a representative clinical sample using validated scales like the Summary of Diabetes Self-Care Activities (SDSCA) and Kessler Psychological Distress Scale (K10). RESULT: The study enrolled a total of 108 subjects with the mean age being 56.3 years. The everyday healthy eating plan was followed by 76.85% (N = 83) subjects and daily physical activity for at least 30 min performed by 50% (54) subjects. Only 12.04% (13) subjects tested their blood sugar and 6.48% (7) respondents checked their feet daily. There was no significant difference found between the SDSCA and psychological distress based on socio-demographic variables. CONCLUSION: Participants in this study typically reported a good level of self-care behavior particularly for diet followed by exercise whereas the self-care behavior was not adequate for foot care and blood-glucose testing. People were not too anxious about COVID-19. This study highlighted the fact that people with diabetes should monitor their blood sugar levels more often along with their foot care.

Quality of life assessment in chronic wound patients using the Wound-QoL and FLQA-Wk instruments.

OBJECTIVES: To evaluate changes in the quality of life of patients with chronic wounds. METHODS: Quantitative research with a cross-sectional design performed with 100 patients with chronic wounds from a university hospital and a Basic Health Unit in southern Brazil. The mean values of the domains of the instruments Wound Quality of Life (Wound-QoL) and Freiburg Life Quality Assessment Wound were compared with sociodemographic variables of age, sex and education. RESULTS: The average age of the participants was 60.98 years old; 41% (n = 41) had diabetic ulcers and 83% (n = 83) treated the wounds for more than 24 months. The total quality of life value was below the mean with 37.50/100 with (Wound-QoL) and 44.20/100 with (FLQA-Wk). The variables of gender, and educational level were not correlated with either of the two instruments used to assess the quality of life. The age variable was significantly correlated with the satisfaction item of the FLQA-Wk. CONCLUSIONS: The quality of life of patients with chronic wounds was considered poor. The age variable was correlated with the satisfaction domain, showing that the older the age, the lower the satisfaction. The use of instruments to evaluate the quality of life of patients with chronic wounds may help an effective treatment plan.