How far has diabetes-related foot disease research progressed in Australia? A bibliometric review (1970-2023).

BACKGROUND: Diabetes-related foot disease (DFD) is a leading cause of the Australian and global disease burdens and requires proportionate volumes of research to address. Bibliometric analyses are rigorous methods for exploring total research publications in a field to help identify volume trends, gaps and emerging areas of need. This bibliometric review aimed to explore the volume, authors, institutions, journals, collaborating countries, research types and funding sources of Australian publications investigating DFD over 50 years. METHODS: A systematic search of the Scopus® database was conducted by two independent authors to identify all Australian DFD literature published between 1970 and 2023. Bibliometric meta-data were extracted from Scopus®, analyzed in Biblioshiny, an R Statistical Software interface, and publication volumes, authors, institutions, journals and collaborative countries were described. Publications were also categorised for research type and funding source. RESULTS: Overall, 332 eligible publications were included. Publication volume increased steadily over time, with largest volumes (78%) and a 7-fold increase over the last decade. Mean co-authors per publication was 5.6, mean journal impact factor was 2.9 and median citation was 9 (IQR2-24). Most frequent authors were Peter Lazzarini (14%), Vivienne Chuter (8%) and Jonathon Golledge (7%). Most frequent institutions affiliated were Queensland University Technology (33%), University Sydney (30%) and James Cook University (25%). Most frequent journals published in were Journal Foot and Ankle Research (17%), Diabetic Medicine (7%), Journal Diabetes and its Complications (4%) and International Wound Journal (4%). Most frequent collaborating countries were the United Kingdom (9%), the Netherlands (6%) and the United States (5%). Leading research types were etiology (38%), treatment evaluation (25%) and health services research (13%). Leading funding sources were no funding (60%), internal institution (16%) and industry/philanthropic/international (10%). CONCLUSIONS: Australian DFD research increased steadily until more dramatic increases were seen over the past decade. Most research received no funding and mainly investigated etiology, existing treatments or health services. Australian DFD researchers appear to be very productive, particularly in recent times, despite minimal funding indicating their resilience. However, if the field is to continue to rapidly grow and address the very large national DFD burden, much more research funding is needed in Australia, especially targeting prevention and clinical trials of new treatments in DFD.

Lateral Wedging of the Foot: A Scoping Review.

Lateral wedges are a common intervention used to alter biomechanical function of the lower limb. Although there is evidence investigating the use and impact of lateral wedges in individuals with medial knee osteoarthritis, knowledge of how these wedges affect foot function in healthy adults is limited. Therefore, this study intends to investigate how lateral wedging affects foot function in healthy adults and, furthermore, how wedge design influences the outcome. The framework outlined by Arksey and O'Malley was used for this scoping review. To ensure methodologic quality and transparent reporting, the study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews preferred reporting guidelines. A systematic search was conducted using MEDLINE by means of EBSCO; SPORT Discuss; CINAHL; AMED by means of OVID; and Scopus. The initial search yielded 252 articles in total; 21 studies were included in the final analysis. Significant incongruence exists in descriptions of wedge length among the 21 included studies. Thirteen studies (61%) reported using full-length wedges, five studies did not report wedge length, and only one study analyzed more than one wedge length. Ethylene vinyl acetate was the most common material, and reporting of hardness was inconsistent. A broad range of inclination angles were used, with limited explanation for why these values were selected. All but one study that analyzed ankle/subtalar joint frontal plane moments reported an increase in the external eversion moment. The review identified significant variation in the design of wedges used within this body of work and a lack of investigation into the influence of wedge design. Wedge design appears to be a secondary consideration, with very few studies examining multiple material types or wedge placements. All but one of the included studies reported a significant change in ankle/subtalar joint moments with lateral wedging. Unfortunately, further generalization was not possible because of the inconsistency and variation.

How does the clinical practice of Aotearoa New Zealand podiatrists align with international guidelines for the prevention of diabetes-related foot disease? A cross-sectional survey.

BACKGROUND: Given the importance of preventive care for the lower limb in people with diabetes, and the absence of local guidelines in Aotearoa New Zealand (NZ), the aim of this study was to determine the alignment of assessment and management used in the prevention of diabetes-related foot disease by NZ podiatrists to the international prevention guideline recommendations. METHODS: A 37-item web-based survey was developed using a 5-point Likert scale (0 = always; 5 = never) based on the International Working Group of the Diabetic Foot (IWGDF) 2019 prevention guidelines and included domains on participant demographics, sector, caseloads, guidelines, screening, management, education, and referral. The survey was distributed to NZ podiatrists through the NZ podiatry association and social media. Participants completing > 50% of items were included. The Mann-Whitney U test was used to examine differences between sector subgroups. RESULTS: Seventy-seven responses (16.3% of the NZ podiatry workforce) were received, of which 52 completed > 50% of items and were included. Of those 52 podiatrists, 73% were from the private sector. Public sector podiatrists reported higher weekly caseloads of patients with diabetes (p = 0.03) and foot ulcers (p < 0.001). The New Zealand Society for the Study of Diabetes (NZSSD) risk stratification pathway and IWGDF guidelines were the two most frequently utilised guidance documents. Participants reported median scores of at least "often" (< 2) for all items in the assessment and management, inspection, examination, and education provision domains for people with a high-risk foot. More than 50% of respondents reported screening more frequently than guideline recommendations for people with a very low to moderate risk foot. Structured education program was only used by 4 (5%) participants. Public sector podiatrists reported greater provision of custom-made footwear (p = 0.04) and multi-disciplinary team care (p = 0.03). CONCLUSION: NZ podiatrists generally follow international guideline recommendations with respect to screening, self-care education, appropriate footwear, and treatment of risk factors for people at-risk of diabetes-related foot disease. However there may be over-screening of people with very low to medium risk occurring in clinical practice. Increasing access to integrated healthcare, custom-made footwear and structured educational programmes appear to be areas of practice that could be developed in future to help prevent diabetes-related foot disease in NZ.

Variability of toe pressures during haemodialysis: comparison of people with and without diabetes; a pilot study.

BACKGROUND: Diabetes, end stage renal disease (ESRD), and peripheral arterial disease (PAD) are associated with a higher risk of diabetes-related lower limb amputation. Timely identification of PAD with toe systolic blood pressure (TSBP) and toe-brachial pressure index (TBPI) is critical in order to implement foot protection strategies to prevent foot complications in people with ESRD. There is limited evidence describing the effect of haemodialysis on TSBP and TBPI. This study aimed to determine the variability of TSBP and TBPI during haemodialysis in people with ESRD, and to determine whether any observed variability differed between people with and without diabetes. METHODS: TSBP and TBPI were taken before dialysis (T1), one hour into dialysis (T2) and in the last 15 min of dialysis (T3) during a single dialysis session. Linear mixed effects models were undertaken to determine the variability in TSBP and TBPI across the three time points and to determine whether this variability differed between people with and without diabetes. RESULTS: Thirty participants were recruited, including 17 (57%) with diabetes and 13 (43%) with no diabetes. A significant overall reduction in TSBP was observed across all participants (P < 0.001). There was a significant reduction in TSBP between T1 and T2 (P < 0.001) and between T1 and T3 (P < 0.001). There was no significant overall change in TBPI over time (P = 0.62). There was no significant overall difference in TSBP between people with diabetes and people with no diabetes (mean difference [95% CI]: -9.28 [-40.20, 21.64], P = 0.54). There was no significant overall difference in TBPI between people with diabetes and people with no diabetes (mean difference [95% CI]: -0.01 [-0.17, 03.16], P = 0.91). CONCLUSION: TSBP and TBPI are an essential part of vascular assessment of the lower limb. TBPI remained stable and TSBP significantly reduced during dialysis. Given the frequency and duration of dialysis, clinicians taking toe pressures to screen for PAD should be aware of this reduction and consider how this may have an impact on wound healing capacity and the development of foot related complications.

The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand.

BACKGROUND: Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar aspect of the first metatarsophalangeal joint (1MTPJ). However, there are currently no recommendations or clinical guidelines to support podiatrists in their assessment or management of sesamoiditis. The aim of this study was to explore the views of podiatrists in Aotearoa New Zealand on their approaches to the assessment and management of patients with sesamoiditis. METHODS: This qualitative study included focus group discussions with registered podiatrists. Focus groups took place online via Zoom and were guided by a detailed focus group question schedule. The questions were designed to encourage discussion around assessment approaches used in the diagnosis of sesamoiditis and the treatment tools used to manage patients with sesamoiditis. Focus groups were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data. RESULTS: A total of 12 registered podiatrists participated in one of three focus groups. Four themes were constructed relating to the assessment of sesamoiditis: (1) obtaining a patient history; (2) recreating patient symptoms; (3) determining contributing biomechanical factors; and (4) ruling out differential diagnoses. Seven themes were constructed relating to the management of sesamoiditis: (1) consideration of patient factors; (2) patient education; (3) cushioning of the sesamoids to allow more comfortable weightbearing of the 1MTPJ; (4) pressure redistribution and offloading of the sesamoids; (5) immobilisation of the 1MTPJ and sesamoids; (6) facilitating efficient sagittal plane motion during gait; (7) referring to other health professionals to find different ways to treat or manage patient symptoms. CONCLUSION: Podiatrists in Aotearoa New Zealand demonstrate an analytical approach in the assessment and management of patients with sesamoiditis based on their clinical experience and knowledge of lower limb anatomy. A range of assessment and management techniques are selected based on the practitioners personal preferences, as well as the patient's social factors, symptomology, and lower limb biomechanics.

Salpingitis in an Adolescent Female With Constipation and Abdominal Pain.

Abdominal pain is one of the most common presenting complaints in the emergency room for pediatric patients. While constipation is one of the most common causes for abdominal pain in pediatrics, serious intra-abdominal pathology must always be excluded. We report a pre-coital post-menarchal adolescent female who presented with severe abdominal pain and constipation and had radiographic findings of salpingitis. It was suspected that uterine and adnexal changes seen on imaging resulted from the fecal mass compressing the genitourinary tract leading to fluid collection manifesting as radiographic evidence of salpingitis. This mechanism is similar to bladder outlet obstruction resulting from compression by intestinal stool burden, leading to urinary stasis, bacteriuria, and ascending urinary tract infection. This case demonstrates how a common pediatric problem, constipation, can lead to a condition rarely found in the pre-coital adolescent population.

Utilizing Structured Worksheets to Strengthen Resident Teaching on the OB/GYN Clerkship.

OBJECTIVE: To determine if structured worksheets can aid resident teaching on the obstetrics and gynecology (OB/GYN) clerkship. DESIGN: We developed structured worksheets to aid residents in teaching medical students. In this pilot study, we measured the impact of the material by conducting end of clerkship focus groups between October 2017 to June 2018 and administering surveys to medical students who had recently completed the clerkship. We performed analyses of the focus group transcriptions for positive and negative themes and analyzed questionnaire data utilizing unpaired t-test and chi-square test to determine whether resident use of structured worksheets influenced student perception of resident teaching quality. SETTING: Medical students rotated at either an academically affiliated public safety-net hospital or tertiary maternity care hospital. PARTICIPANTS: Medical students completing the OB/GYN clerkship volunteered to participate. RESULTS: A total of 37 students participated in focus groups and completed the survey. Focus group comments revealed a generally positive attitude towards the structured worksheets. The survey data revealed that this material helped to facilitate student's clinical reasoning skills and assisted residents in using questions to effectively teach. CONCLUSIONS: Structured worksheets can aid resident teaching on the OB/GYN clerkship. Students perceived the teaching material most favorably when residents utilized the material in a purposeful and timely manner. Effective resident use of structured worksheets on the OB/GYN clerkship can strengthen a culture that promotes student learning. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01318-7.

Labeling of cancer cells with magnetic nanoparticles for magnetic resonance imaging.

PURPOSE: The process of invasion and metastasis formation of tumor cells can be studied by following the migration of labeled cells over prolonged time periods. This report investigates the applicability of iron oxide nanoparticles as a magnetic resonance imaging (MRI) contrast agent for cell labeling. METHODS: γFe2 O3 nanoparticles prepared with direct flame spray pyrolysis are biofunctionalized with poly-l-lysine (PLL). The nanoparticles within the cells were observed with transmission electron microscopy, bright-field microscopy, and magnetorelaxometry. MRI of labeled cells suspended in agarose was used to estimate the detection limit. RESULTS: PLL-coated particles are readily taken up, stored in intracellular clusters, and gradually degraded by the cells. During cell division, the nanoparticle clusters are divided and split between daughter cells. The MRI detection limit was found to be 25 cells/mm(3) for R2*, and 70 cells/mm(3) for R2. The iron specificity, however, was higher for R2 images. Due to the degradation of intracellular γFe2 O3 to paramagnetic iron ions within 13 days, the R1, R2, and R2* contrast gradually decreased over this time period to approximately 50% of its initial value. CONCLUSIONS: These results suggest that PLL-coated γFe2 O3 nanoparticles can be used as an MRI contrast agent for long-term studies of cell migration. Magn Reson Med 71:1896-1905, 2014. © 2013 Wiley Periodicals, Inc.

The effect of polymer coatings on proton transverse relaxivities of aqueous suspensions of magnetic nanoparticles.

Iron oxide magnetic nanoparticles are good candidates for magnetic resonance imaging (MRI) contrast agents due to their high magnetic susceptibilities. Here we investigate 19 polyether-coated magnetite nanoparticle systems comprising three series. All systems were synthesized from the same batch of magnetite nanoparticles. A different polyether was used for each series. Each series comprised systems with systematically varied polyether loadings per particle. A highly significant (p < 0.0001) linear correlation (r = 0.956) was found between the proton relaxivity and the intensity-weighted average diameter measured by dynamic light scattering in the 19 particle systems studied. The intensity-weighted average diameter measured by dynamic light scattering is sensitive to small number fractions of larger particles/aggregates. We conclude that the primary effect leading to differences in proton relaxivity between systems arises from the small degree of aggregation within the samples, which appears to be determined by the nature of the polymer and, for one system, the degree of polymer loading of the particles. For the polyether coatings used in this study, any changes in relaxivity from differences in water exclusion or diffusion rates caused by the polymer are minor in comparison with the changes in relaxivity resulting from variations in the degree of aggregation.

Nanostructure of PEO-polyurethane-PEO triblock copolymer micelles in water.

Novel hydrophilic triblock copolymers which form micelles in aqueous solution were studied by static and dynamic light scattering (SLS and DLS), small angle neutron scattering (SANS) and densitometry. The polymers were symmetric A-B-A block copolymers having two poly(ethylene oxide) (PEO) tail blocks and a polyurethane (PU) center segment that contained pendant carboxylic acids. The aggregation number of the micelles decreased with increasing PEO mass content. When attempting to fit the SANS data it was found that no single model was suitable over the entire range of block lengths and PEO mass concentrations investigated here. For the polymer with the highest aggregation number, the data were fitted with a triblock model consisting of a homogeneous core with a corona of non-interacting Gaussian chains for which only two free parameters were required: the radius of the core and the radius of gyration of the corona. In this case, the core was found to be effectively dry. At lower aggregation numbers, a star polymer model generated significantly better fits, suggesting the absence of any identifiable central core structure. Good agreement was found between the sizes measured by DLS, SANS and theoretical predictions of micelle size from a density distribution theory. These results show that when significant changes in aggregation number occur, the nanostructure of the micelle can change substantially even for polymers that are remarkably similar.

Experimental validation of proton transverse relaxivity models for superparamagnetic nanoparticle MRI contrast agents.

Analytical models of proton transverse relaxation rate enhancement by magnetic nanoparticles were tested by making measurements on model experimental systems in a field of 1.4 T. Proton relaxivities were measured for five aqueous suspensions of iron oxide (maghemite) nanoparticles with nominal mean particle sizes of 6, 8, 10, 11, and 13 nm. Proton relaxivity increased with mean particle size ranging from 13 s(-1) mM Fe(-1) for the 6 nm sample, up to 254 s(-1) mM Fe(-1) for the 13 nm sample. A strong correlation between the measured and predicted values of the relaxivity was observed, with the predicted values being consistently higher than the measured values. The results indicate that the models give a reasonable agreement with experimental results and hence can be used as the basis for the design of new magnetic resonance imaging contrast and labelling agents.

Stability of polydimethylsiloxane-magnetite nanoparticle dispersions against flocculation: interparticle interactions of polydisperse materials.

The colloidal stability of dispersions comprised of magnetite nanoparticles coated with polydimethylsiloxane (PDMS) oligomers was investigated theoretically and experimentally. Particle-particle interaction potentials in a theta solvent and in a good solvent for the PDMS were predicted by calculating van der Waals, electrostatic, steric, and magnetic forces as functions of interparticle separation distances. A variety of nanoparticle sizes and size distributions were considered. Calculations of the interparticle potential in dilute suspensions indicated that flocculation was likely for the largest 1% of the population of particles. Finally, the rheology of these complexes over time in the absence of a solvent was measured to probe their stabilities against flocculation as neat fluids. An increase in viscosity was observed upon aging, suggesting that some agglomeration occurs with time. However, the effects of aging could be removed by exposing the sample to high shear, indicating that the magnetic fluids were not irreversibly flocculated.