Objective: Diabetes-related foot ulceration (DFU) is a common limb-threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to the healing of diabetes-related foot ulceration in an Australian population. Research design and methods:This was a prospective cohort study of individuals with diabetes-related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. The index of relative socio-economic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire-short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over 6 months. Logistic regression was performed to determine the relationship between healing and diet quality, toe systolic pressure, wound size at, IRSD, infection and previous amputation.Results: A total of 117 participants were included. The majority were male n = 96 (82%), socio-economically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36 kg/m 2 , SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n = 85, 73%) and classified 1A (n = 63, 54%) on the University of Texas wound classification system with few infections (n = 23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95% 1.28-14.84, p = 0.02), and greater levels of socio-economic advantage were also associated with increased odds of healing (OR 1.01, 95% CI 1.01-1.02, p = 0.03). Conclusions:In this cohort study of predominantly neuropathic, non-infected DFU, individuals who had greater levels of socio-economic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal.
Background People with diabetes are at high risk of foot complications that can lead to lower extremity amputations. National standards suggest that early assessment and management by a podiatry led multidisciplinary high-risk foot clinic (HRFC) helps to reduce complications. This review is a retrospective audit of the Central Coast Local Health District (CCLHD) podiatry department service utilisation in people with diabetes who had undergone a minor foot amputation. Methods All people with diabetes who had minor foot amputations in the calendar year 2017 in the CCLHD in New South Wales were identified. Podiatry occasions of service from all podiatry service clinics (e.g. general, orthoses, wound, HRFC) and hospital stays for 12 months prior to, and 12 months, post the minor foot amputation were extracted. Results Data on 74 people with diabetes who underwent 85 minor foot amputations were collected. In the 12-month period leading up to their minor foot amputation less than half, 42% (n=31), of the patients had attended any of the available podiatry service clinics within the CCLHD system. Post-amputation and discharge from hospital there was an overall rise of 26% in numbers attending all CCLHD podiatry- led clinics bringing the total to 68% (51). However, attendance at the HRFC rose by only 2% from 16% (n=12) to 18% n= (13). Conclusion This study shows that there was underutilisation of Podiatry Services in the CCLHD in 2017 with some participants not meeting national treatment guidelines for foot health services. Revision of current referral pathways both prior to, during and following hospitalisation and expanding the multidisciplinary HRFC to accommodate the population by providing more accessible locations has since been undertaken to increase service access. Further provision of education to those highlighted to be at high risk has also been implemented.
Marked differences in the structure and physiology of the mucous membranes as compared with the skin would lead one to expect differences in their reaction to irritants. This is borne out by the observations of Duncan' and of Cooper,2 who showed that poison ivy leaf (Rhus toxicodendron) may be chewed with impunity by susceptible persons, but contact of the leaf or saliva with the skin about the month results in a severe reaction. The nasal mucosa is the primary shock tissue in cases of allergic rhinitis. Nasal tests, therefore, should be more specific and give more reliable information than skin tests in such cases.The advantages of the skin tests are principally the relative ease of application, the large number of tests that can be run at one time, and the relative freedom from severe reactions. The failure of the skin to react in many cases of allergic rhinitis, and its tendency to react to great numbers of allergens that the nasal mucosa is not sensitive to, reduces the value of the test as a diagnostic procedure in this condition. Rackemann and Simon 3 found 8 per cent of positive skin reactions in persons showing no symptoms of hypersensitiveness. It is obvious that any of the various methods of parenteral administration of antigenic substance, which results in absorption into the blood stream, may cause sensitization of the skin.The limited number of tests that can be performed, and the severe symptoms often resulting from the methods of testing m vogue, has prevented general use of mucosal tests in the nose.
Wound chronicity in diabetic foot ulceration (DFU) presents a significant cost to the healthcare system and also increases the likelihood of infection and amputation. Factors such as dietary intake, smoking, vascular status and infection have been proposed as contributory factors for chronicity. However, there is limited quality evidence to demonstrate the contribution of these factors in delayed healing in DFU. The aims of this research protocol are therefore to assess factors contributing to healing outcomes and wound chronicity in people with DFU, and to measure dietary intake in patients with DFU in an Australian setting.
Purpose of study: To investigate toe systolic blood pressure and/or toe-brachial pressure index in predicting healing post minor diabetic foot amputations. Key methods: A systematic search of EMBASE and PubMed (including Medline and The Cochrane Library) was conducted from database inception to 9 March 2020. Two authors independently reviewed and selected relevant studies. Quality was assessed with a modified Critical Appraisal Skill Programme checklist. Main results: Ten studies met the inclusion criteria. Nine studies investigating toe systolic blood pressure reported healing occurred at mean toe systolic blood pressure values ⩾30 mmHg, ranging between 30 and 83.6 mmHg. The meta-analysis (four studies) found toe systolic blood pressure <30 mmHg had 2.09 times the relative risk of non-healing post amputation, compared to toe systolic blood pressure ⩾30 mmHg (relative risk = 2.09, 95% confidence interval: 1.37–3.20, p = 0.001). Two studies investigating toe-brachial pressure index report successful healing where toe-brachial pressure index >0.2, with one study reporting a higher value of 0.8. Main conclusions: Successful post-amputation healing outcomes were reported at mean toe systolic blood pressure ⩾30 mmHg, and the results varied considerably between the studies. Further research should identify whether variables, including amputation level, method of wound closure and length of post-operative follow-up periods, affect the values of toe systolic blood pressure and toe-brachial pressure index observed in this review.
The normal secretions of the sinuses is a grayish, viscous fluid that bathes the entire lining membrane, protecting it and assisting the ciliated epithelium in the removal of foreign substances. The physical properties of this fluid and its r\l=o^\lein the protection of the sinuses have been studied by Yates,1 Walthard 2 and Stark.3 Bacteriologic observations by T\l=o"\rne,4 Frankel,5 Calamida and Bartarelli,6 and Linton7 indicate that the normal nasal sinus is usually sterile. The important r\l=o^\le played by the ciliated epithelium in producing this result is recognized; however, it has long been suspected that some antibacterial substance in the secretions is a contributing factor. It was the object of this study to determine whether such a substance exists, and, if it does, to find out something of its nature.According to Hilding,8 the normal histology of the sinus in man shows numerous goblet cells in the epithelium and the glands of the tubular and compound racemose types in the submucosa ; the latter may be mucous, serous or mixed. It is evident, therefore, that the secretion may vary in consistency, depending on the relative activity of the mucous and serous glands. Under normal conditions, however, the amount of variation is slight. The principal constituent and the one that imparts its characteristic viscous properties to the secretion is the mucus as
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