1,721,073 research outputs found
A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable
No full textDiabetic foot ulceration poses a heavy burden on the patient and the healthcare system, but prevention thereof receives little attention. For every euro spent on ulcer prevention, ten are spent on ulcer healing, and for every randomized controlled trial conducted on prevention, ten are conducted on healing. In this article, we argue that a shift in priorities is needed. For the prevention of a first foot ulcer, we need more insight into the effect of interventions and practices already applied globally in many settings. This requires systematic recording of interventions and outcomes, and well-designed randomized controlled trials that include analysis of cost-effectiveness. After healing of a foot ulcer, the risk of recurrence is high. For the prevention of a recurrent foot ulcer, home monitoring of foot temperature, pressure-relieving therapeutic footwear, and certain surgical interventions prove to be effective. The median effect size found in a total of 23 studies on these interventions is large, over 60%, and further increases when patients are adherent to treatment. These interventions should be investigated for efficacy as a state-of-the-art integrated foot care approach, where attempts are made to assure treatment adherence. Effect sizes of 75-80% may be expected. If such state-of-the-art integrated foot care is implemented, the majority of problems with foot ulcer recurrence in diabetes can be resolved. It is therefore time to act and to set a new target in diabetic foot care. This target is to reduce foot ulcer incidence with at least 75
The association of chronic kidney disease and dialysis treatment with foot ulceration and major amputation
No full textObjective\ud
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The objective of this study was to investigate the risk of chronic kidney disease (CKD) stage 4-5 and dialysis treatment on incidence of foot ulceration and major lower extremity amputation in comparison to CKD stage 3.\ud
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Methods\ud
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In this retrospective study, all individuals who visited our hospital between 2006 and 2012 because of CKD stages 3 to 5 or dialysis treatment were included. Medical records were reviewed for incidence of foot ulceration and major amputation. The time from CKD 3, CKD 4-5, and dialysis treatment until first foot ulceration and first major lower extremity amputation was calculated and analyzed by Kaplan-Meier curves and multivariate Cox proportional hazards model. Diabetes mellitus, peripheral arterial disease, peripheral neuropathy, and foot deformities were included for potential confounding.\ud
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Results\ud
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A total of 669 individuals were included: 539 in CKD 3, 540 in CKD 4-5, and 259 in dialysis treatment (individuals could progress from one group to the next). Unadjusted foot ulcer incidence rates per 1000 patients per year were 12 for CKD 3, 47 for CKD 4-5, and 104 for dialysis (P < .001). In multivariate analyses, the hazard ratio for incidence of foot ulceration was 4.0 (95% confidence interval [CI], 2.6-6.3) in CKD 4-5 and 7.6 (95% CI, 4.8-12.1) in dialysis treatment compared with CKD 3. Hazard ratios for incidence of major amputation were 9.5 (95% CI, 2.1-43.0) and 15 (95% CI, 3.3-71.0), respectively.\ud
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Conclusions\ud
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CKD 4-5 and dialysis treatment are independent risk factors for foot ulceration and major amputation compared with CKD 3. Maximum effort is needed in daily clinical practice to prevent foot ulcers and their devastating consequences in all individuals with CKD 4-5 or dialysis treatment
Comment on Crews et al. Role and Determinants of Adherence to Off-loading in Diabetic Foot Ulcer Healing: A Prospective Investigation. Diabetes Care 2016;39:1371-1377
Get PDFWe read with great interest the article by Crews et al. (1), which investigated the role and determinants of adherence to off-loading in diabetic foot ulcer healing. The authors found that greater off-loading adherence contributes to better ulcer outcomes and that postural instability is a key barrier to nonadherence. As the authors rightly stress, adherence to wearing an off-loading device is considered of great clinical importance; yet, research to substantiate this has been lacking. We congratulate the authors on this important study and particularly their use of a validated method to measure adherence. However, we want to address three aspects that limit broader interpretation.\ud
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First, the primary clinical outcome chosen was ulcer area reduction at 6 weeks. Although predictive of ulcer healing, it is a surrogate clinical outcome; the recommended outcome to be reported is ulcers healed by a fixed time, with 12 weeks used in most studies (2,3). A reason for using this surrogate outcome is not provided. It may be that the adherence monitor could only measure for a limited time period, judging by the mean use of 35 days. Yet, even without measuring adherence for the full treatment period, reporting the recommended outcome of healing at 12 weeks would have allowed for direct comparison with similar studies on off-loading (3).\ud
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Second, only baseline participant characteristics (Table 1 in ref. 1) and β-coefficients of predictors of ulcer healing and off-loading adherence from multivariate models (Tables 2 and 3 in ref. 1) are reported. Again, this article may have been enhanced and allowed a better comparison with other studies if univariate and multivariate regression results for all baseline characteristics were reported as well.\ud
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Third, objective measurements of plantar pressure were not conducted. In this study, different off-loading devices were used, with the majority of participants (77%) using a removable cast walker. Subgroup results of the different devices would have increased our understanding of their effect on outcomes. However, with the great variation in foot morphology in people with diabetic foot ulcers, the foot-device interface always differs across patients. As diabetic foot ulcer healing depends on the reduction of mechanical stress at the ulcer site, plantar pressure and the variation thereof across patients may have impacted outcomes (4). Mechanical stress is likely to be a strong predictor in multivariate analysis of ulcer healing, and measuring this in addition to adherence would have further improved our understanding of the outcomes found. In our view, this should be standard in studies on off-loading adherence and ulcer healing (5).\ud
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In conclusion, we commend the authors for performing this much needed study on off-loading adherence and diabetic foot ulcer healing. We hope the authors can provide the following additional information (published as an online appendix) to address the three aspects discussed in this letter: 12-week healing outcomes, univariate and multivariate regression results for all baseline characteristics, and subgroup results on clinical and adherence outcomes for the different off-loading devices. Such information would further enhance the scientific merits of this article and enable better clinical interpretation and comparison with past and future studies
Assessment of signs of foot infection in diabetes patients using photographic foot imaging and infrared thermography
No full textPatients with diabetic foot disease require frequent screening to prevent complications and may be helped through telemedical home monitoring. Within this context, the goal was to determine the validity and reliability of assessing diabetic foot infection using photographic foot imaging and infrared thermography. For 38 patients with diabetes who presented with a foot infection or were admitted to the hospital with a foot-related complication, photographs of the plantar foot surface using a photographic imaging device and temperature data from six plantar regions using an infrared thermometer were obtained. A temperature difference between feet of >2.2 °C defined a "hotspot." Two independent observers assessed each foot for presence of foot infection, both live (using the Perfusion-Extent-Depth-Infection-Sensation classification) and from photographs 2 and 4 weeks later (for presence of erythema and ulcers). Agreement in diagnosis between live assessment and (the combination of ) photographic assessment and temperature recordings was calculated. Diagnosis of infection from photographs was specific (>85%) but not very sensitive ( 90%) but not very specific ( 60%) and specific (>79%). Intra-observer agreement between photographic assessments was good (Cohen's κ=0.77 and 0.52 for both observers). Diagnosis of foot infection in patients with diabetes seems valid and reliable using photographic imaging in combination with infrared thermography. This supports the intended use of these modalities for the home monitoring of high-risk patients with diabetes to facilitate early diagnosis of signs of foot infectio
Epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia: a systematic review protocol
No full textBackground\ud
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Diabetic foot disease is associated with major morbidity, mortality, costs, and reduction of a person’s quality of life. Investigating the epidemiology of diabetic foot disease is the backbone of diabetic foot research and clinical practice, yet the full burden of diabetic foot disease in Australia is unknown. This study aims to describe the protocol for a systematic review of the epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia.\ud
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Methods—search\ud
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The systematic review will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed and EMBASE will be searched for publications in any language and without restrictions to date. Two independent investigators will screen publications for eligibility, with publications reporting Australian population-based incidence or prevalence of diabetic foot disease or diabetes-related lower-extremity amputation to be included. Additionally, a forward literature search will be performed in Google Scholar, and a grey literature search will be performed to identify government publications.\ud
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Methods—assessment\ud
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Quality assessment will be performed using customised checklists. The summary statistic used for each study will be an incidence or prevalence proportion of diabetic foot disease or diabetes-related lower-extremity amputation. The standard error for each proportion will be calculated. A meta-analysis will be performed when three or more publications of adequate quality, reporting on similar outcomes and in similar populations, are identified.\ud
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Discussion\ud
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The results of this systematic review can be used to adequately inform stakeholders in the field of diabetic foot disease on the extent of the problem in incidence and prevalence of diabetic foot disease in Australia, and to help guide appropriate use of resources to reduce the burden of this disease
Infrared thermal imaging for automated detection of diabetic foot complications
Get PDFBackground: Although thermal imaging can be a valuable technology in the prevention and management of diabetic foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of diabetic foot disease. Conclusions: With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of diabetic foot disease and to discriminate between no, local, or diffuse diabetic foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of diabetic foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings
8-13 hz fluctuations in rectal pressure are an objective marker of clitorally-induced orgasm in women
No full textOrgasm is a subjective experience accompanied by involuntary muscle contractions. We hypothesized that orgasm in women would be distinguishable by frequency analysis of a perineal muscle-derived signal. Rectal pressure, an index of perineal muscle activity, was measured continuously in 23 healthy women during different sexual tasks: receiving clitoral stimulation, imitation of orgasm, and attempt to reach orgasm, in which case the women were asked to report whether orgasm had been reached ("orgasm") or not ("failed orgasm attempt"). We performed spectral analysis on the rectal pressure data and calculated the spectral power in the frequency bands delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-25 Hz). The most significant and most important difference in spectral power between orgasm and both control motor tasks (imitation of orgasm and failed orgasm attempt) was found in the alpha band. An objective rule based on spectral power in the alpha band recognized 94% (29/31) of orgasms and correctly labeled 69% (44/64) of all orgasm attempts as either successful or failed. Because outbursts of alpha fluctuations in rectal pressure only occurred during orgasm and not during voluntary imitation of orgasm or failed attempts, we propose that they represent involuntary contractions of muscles in the rectal vicinity. This is the first objective and quantitative measure that has a strong correspondence with the subjective experience of orgasm
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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