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Advances in Skin & Wound Care Jan 2023To review the literature to determine whether compression therapies and nutrition status influence venous ulcer healing.
OBJECTIVE
To review the literature to determine whether compression therapies and nutrition status influence venous ulcer healing.
DATA SOURCE
A systematized bibliographic review was carried out by searching PubMed, Scopus, and Cochrane databases for studies published between 2015 and 2020, using descriptors in Spanish and English.
STUDY SELECTION
After establishing the research question and applying the filters based on inclusion and exclusion criteria, 114 articles were found. After screening, 11 articles were selected for the review: 8 were identified in the literature search, and 3 were added from the bibliographic references of other studies.
DATA EXTRACTION
The authors developed a data extraction sheet that recorded the following variables: author, country, year of publication, level of evidence, research design, therapy type, initial ulcer size, active ulcer history, pain, healed wounds, wound reduction, therapy tolerance, nutrition assessment method, body mass index, and nutrition disorders.
DATA SYNTHESIS
Four studies analyzed the relationship between nutrition status and venous ulcer healing, finding that these patients tend to have a high body mass index; a deficit of nutrients such as vitamin A, D, or zinc; and an excess of lipids and carbohydrates. Seven studies compared different types of compression to determine which provided the best results, with two- and four-layer therapy being the most commonly used. Variables such as small wound size and recent onset were associated with better prognosis.
CONCLUSIONS
In terms of nutrition, the parameters analyzed are very limited. Although several studies show that two-layer therapy produces the greatest ulcer healing, there is not enough information to recommend one type of therapy over the other. Therefore, more clinical trials are needed to study broader nutrition parameters and compare the types of therapy under matched conditions to determine their influence on ulcer healing.
Topics: Humans; Varicose Ulcer; Ulcer; Nutritional Status; Body Mass Index; Wound Healing
PubMed: 36537775
DOI: 10.1097/01.ASW.0000902492.97059.f2 -
Journal of Foot and Ankle Research Mar 2020Multidisciplinary team (MDT) approach has been shown to reduce diabetic foot ulcerations (DFUs) and lower extremity amputations (LEAs), but there is heterogeneity... (Meta-Analysis)
Meta-Analysis
Multidisciplinary team (MDT) approach has been shown to reduce diabetic foot ulcerations (DFUs) and lower extremity amputations (LEAs), but there is heterogeneity between team members and interventions. Podiatrists have been suggested as "gatekeepers" for the prevention and management of DFUs. The purpose of our study is to review the effect of podiatric interventions in MDTs on DFUs and LEAs. We conducted a systematic review of available literature. Data's heterogeneity about DFU outcomes made it impossible for us to include it in a meta-analysis, but we identified 12 studies fulfilling inclusion criteria that allowed for them to be included for LEA outcomes. With the exception of one study, all reported favourable outcomes for MDTs that include podiatry. We found statistical significance in favour of an MDT approach including podiatrists for our primary outcome (total LEAs (RR: 0.69, 95% CI 0.54-0.89, I = 64%, P = 0.002)) and major LEAs (RR: 0.45, 95% CI 0.23-0.90, I = 67%, P < 0.02). Our systematic review, with a standard search strategy, is the first to specifically address the relevant role of podiatrists and their interventions in an MDT approach for DFU management. Our observations support the literature that MDTs including podiatrists have a positive effect on patient outcomes but there is insufficient evidence that MDTs with podiatry management can reduce the risk of LEAs. Our study highlights the necessity for intervention descriptions and role definition in team approach in daily practice and in published literature.
Topics: Aged; Amputation, Surgical; Diabetic Foot; Female; Humans; Lower Extremity; Male; Middle Aged; Outcome Assessment, Health Care; Patient Care Team; Podiatry
PubMed: 32192509
DOI: 10.1186/s13047-020-0380-8 -
The Orthopedic Clinics of North America Apr 2021As the scope of podiatric surgery expands, the relative roles and outcomes of orthopedic surgeons and podiatrists need to be defined. With growing demand for foot and... (Comparative Study)
Comparative Study
As the scope of podiatric surgery expands, the relative roles and outcomes of orthopedic surgeons and podiatrists need to be defined. With growing demand for foot and ankle services, the roles of podiatrists and orthopedic surgeons are increasingly overlapping. Few studies have examined the overlapping scope of practice of each of the groups or compared the relative costs and outcomes associated with each.
Topics: Ankle Joint; Foot Joints; Humans; Orthopedic Procedures; Orthopedics; Podiatry; Treatment Outcome
PubMed: 33752839
DOI: 10.1016/j.ocl.2020.12.004 -
The Journal of Foot and Ankle Surgery :... Mar 2019Rupture of the tibialis anterior tendon is a rare condition reported to occur most often spontaneously in patients >45 years of age. Diagnosis is often delayed due to... (Meta-Analysis)
Meta-Analysis
Rupture of the tibialis anterior tendon is a rare condition reported to occur most often spontaneously in patients >45 years of age. Diagnosis is often delayed due to transient pain at the time of rupture and the ability of the long extensors to compensate for the lost action of the tibialis anterior. Treatment has been proposed to be based on the activity level of the individual; however, no consensus has been reached on the optimal treatment modality for this rare condition. A systematic review and meta-analysis were performed to determine outcomes obtained with conservative and surgical management. Twenty-four references (155 cases) were identified. Conservative management (21 cases, 13.55%) was associated with poorer outcomes (odds ratio [OR] 0.68; I = 61%) because of pain and functional limitations related to ankle dorsiflexory weakness. Surgical intervention (134 cases, 86.45%) had a better chance for good outcome (OR 8.40; I = 63%). Use of an ipsilateral split/turn-down ipsilateral tibialis anterior tendon graft (OR 32.15; I = 0%) semitendinous autograft (OR 15.25; I = 44%), or direct repair (OR 12.57; I = 0%) provided the best postoperative outcomes, whereas extensor hallucis longus autograft was associated with the worst (OR 0.27, I = 34%). The most common postoperative finding was objective mild dorsiflexory weakness (4/5 muscle strength), which did not translate to subjective functional limitation. Good functional results were found to occur regardless of patient age at the time of intervention. Results of this systematic review and meta-analysis suggests that surgical intervention provides better functional outcomes than conservative management. Use of an extensor hallucis longus autograft is not recommended if surgical intervention is performed.
Topics: Conservative Treatment; Female; Follow-Up Studies; Humans; Injury Severity Score; Male; Middle Aged; Muscle, Skeletal; Recovery of Function; Risk Factors; Rupture; Tendon Injuries; Tendon Transfer; Tibia; Treatment Outcome
PubMed: 30554867
DOI: 10.1053/j.jfas.2018.08.001 -
Advances in Skin & Wound Care Dec 2022To determine if health education has an influence on podiatric knowledge, self-care, and conditions in adults with diabetes mellitus.
OBJECTIVE
To determine if health education has an influence on podiatric knowledge, self-care, and conditions in adults with diabetes mellitus.
DATA SOURCES
The authors conducted a literature search for Spanish-, English-, and Portuguese-language publications using PubMed, Scopus, Dialnet, and CUIDEN.
STUDY SELECTION
Selected keywords related to diabetes, health education, (diabetic) foot, and self-care were searched, and the titles, abstracts, and relevant full-text articles were screened. Thirteen studies were selected with a total of 1,296 participants. Four were randomized controlled trials, and nine were quasi-experimental studies.
DATA EXTRACTION
Data pertaining to preventive intervention and study outcomes were extracted.
DATA SYNTHESIS
The preventive interventions used varied from traditional educational workshops and one-on-one patient education to new technological strategies. Three different outcomes were evaluated in each study: podiatric knowledge (n = 4), foot self-care (n = 13), and foot problems (n = 2).
CONCLUSIONS
Health education interventions increase podiatric self-care in adults with diabetes mellitus. These interventions appear to contribute positively to foot health and podiatric knowledge.
Topics: Adult; Humans; Self Care; Diabetes Mellitus; Podiatry; Health Education
PubMed: 36179316
DOI: 10.1097/01.ASW.0000884328.49506.7a -
The Journal of Foot and Ankle Surgery :... 2024Percutaneous Achilles tendon lengthening is an effective surgical procedure to treat and prevent forefoot and midfoot ulcerations in patients with diabetes. Patients... (Review)
Review
Percutaneous Achilles tendon lengthening is an effective surgical procedure to treat and prevent forefoot and midfoot ulcerations in patients with diabetes. Patients with diabetes are prone to plantar ulcerations due to a combination of factors, such as peripheral neuropathy, decreased tendon elasticity, peripheral vascular disease, and hyperglycemia. Complications such as re-ulceration and transfer lesion to the heel, associated with a calcaneal gait secondary to over-lengthening, are possible with percutaneous Achilles tendon lengthening. Although percutaneous Achilles tendon lengthening is well accepted, the overall incidence of complication has not been well described. A systematic review of the reported data was performed to determine the incidence of complication for percutaneous tendo-Achilles lengthening when used for the treatment and prevention of diabetic plantar ulcerations. Nine studies involving 490 percutaneous lengthening procedures met the inclusion criteria. The overall complication rate was 27.8% (8% with transfer heel ulcerations). Given the high rate of complications associated with a percutaneous Achilles tendon lengthening, careful patient selection and consideration of these risks should be considered prior to proceeding with this procedure. Additional prospective comparative analyses with standardization of surgical technique, degrees of lengthening achieved, and post-operative weightbearing and immobilization modalities are needed to decrease incidence of complication and achieve higher healing rates.
Topics: Humans; Diabetic Foot; Achilles Tendon; Tenotomy; Postoperative Complications
PubMed: 38307408
DOI: 10.1053/j.jfas.2024.01.013 -
Journal of Wound Care Mar 2018Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings...
OBJECTIVE
Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing.
METHOD
A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts.
RESULTS
In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus.
CONCLUSION
This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.
Topics: Administration, Topical; Anti-Infective Agents; Consensus; Delphi Technique; Diabetic Foot; Female; Humans; Male; Matrix Metalloproteinases; Quality of Life; Surgical Wound Infection; Wound Healing; Wounds and Injuries
PubMed: 29509111
DOI: 10.12968/jowc.2018.27.3.156 -
Journal of Foot and Ankle Research 2015Across the Western world, demographic changes have led to healthcare policy trends in the direction of role flexibility, challenging established role boundaries and...
BACKGROUND
Across the Western world, demographic changes have led to healthcare policy trends in the direction of role flexibility, challenging established role boundaries and professional hierarchies. Population ageing is known to be associated with a rise in prevalence of chronic illnesses which, coupled with a reducing workforce, now places much greater demands on healthcare provision. Role flexibility within the health professions has been identified as one of the key innovative practice developments which may mitigate the effects of these demographic changes and help to ensure a sustainable health provision into the future. However, it is clear that policy drives to encourage and enable greater role flexibility among the health professions may also lead to professional resistance and inter-professional role boundary disputes. In the foot and ankle arena, this has been evident in areas such as podiatric surgery, podiatrist prescribing and extended practice in diabetes care, but it is far from unique to podiatry.
METHODS
A systematic review of the literature identifying examples of disputed role boundaries in health professions was undertaken, utilising the STARLITE framework and adopting a focus on the specific characteristics and outcomes of boundary disputes. Synthesis of the data was undertaken via template analysis, employing a thematic organisation and structure.
RESULTS
The review highlights the range of role boundary disputes across the health professions, and a commonality of events preceding each dispute. It was notable that relatively few disputes were resolved through recourse to legal or regulatory mandates.
CONCLUSIONS
Whilst there are a number of different strategies underpinning boundary disputes, some common characteristics can be identified and related to existing theory. Importantly, horizontal substitution invokes more overt role boundary disputes than other forms, with less resolution, and with clear implications for professions working within the foot and ankle arena.
PubMed: 25670968
DOI: 10.1186/s13047-015-0061-1