ObjectiveDiabetic peripheral neuropathy (DPN) is one of the most important risk factors of diabetic foot ulcers, and early screening and treatment of DPN are crucial. The Ipswich Touch Test (IPTT) is a new method for screening for DPN and, compared with traditional methods, is more simple to operate and requires no equipment. However, the screening accuracy of IPTT in patients with DPN has not been well characterised. We aim to conduct a systematic review and meta-analysis to characterise the sensitivity and specificity of IPTT compared with traditional methods and to understand the potential screening value of IPTT.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database up to 16 April 2020.MethodsStata V.15.1 software was used for analysis, and the screening value of IPTT in DPN was described using 10 g monofilament (10g-MF), neuropathy disability scores (NDS), Pin prick, 128 Hz tuning fork, and ankle reflex as reference standards. Sensitivity, specificity and other measures of accuracy of IPTT for screening DPN were pooled based on a quality effects model. The protocol was registered with PROSPERO (42020168420).ResultsOf the 441 records retrieved, 7 studies were evaluated for the screening value of IPTT. Five studies with 10g-MF as the reference standard were included in the meta-analysis, and the pooled sensitivity and specificity were 0.77 (95%CI 0.69–0.84) and 0.96(95%CI 0.93–0.98), respectively, and the area under curve was 0.897. Compared with vibration perception threshold, IPTT showed a sensitivity between 0.76 and 1, and a specificity between 0.90 and 0.97. Compared with NDS, IPTT showed a sensitivity between 0.53 and 1, and a specificity between 0.90 and 0.97. Compared with Pin prick, IPTT showed a sensitivity and specificity of 0.8 and 0.88, respectively. Compared with 128 Hz tuning fork, IPTT showed a sensitivity and specificity of 0.4 and 0.27, respectively. Compared with ankle reflex, IPTT had a sensitivity of 0.2 and a specificity of 0.97.ConclusionsIPTT shows a high degree of agreement with other commonly used screening tools for DPN screening. It can be used clinically, especially in remote areas and in primary medical institutions, and by self-monitoring patients. More high-quality studies are needed to assess and promote more effective screening practices.PROSPERO registration numberRegistration Number is CRD (42020168420).
The purpose of this study is to investigate the influence of an outpatient multidisciplinary diagnosis and treatment model on the health economic indices of diabetic foot patients. We included 142 diabetic foot patients who received treatment in 2 target hospitals from January to April 2018 in this prospective cohort study. According to their exposure factors, the patients were divided into a MDT group and a control group, with 71 patients in each group. The patients’ baseline data were collected. The follow-up period was 12 months; all patients were followed up to April 30, 2019. Health economic indicators were collected when the patients were discharged from the hospital. The prognosis of each group was followed every month. If a wound healed, a major amputation occurred, or the patient died within 12 months, the follow-up was stopped. A total of 129 patients were followed, and their baseline data were comparable. During the follow-up period, the healing rate of the 2 groups was significantly different ( P = .034). The healing rate of Wagner grade 4 patients was significantly better than Wagner grade 2 and grade 3 patients ( P = .001). Health economic indicators demonstrated significant differences in bed waiting time ( P = .038), transfer time ( P = .001), surgery waiting time ( P = .003), length of hospital stay ( P = .047), and hospitalization expenses ( P = .011). In conclusion, an outpatient multidisciplinary diagnosis and treatment model for diabetic foot can support cost-effective patient management.
Background Diabetic foot is a serious complication of diabetes with a high disability and mortality rate, which can be prevented by early screening. General practitioners play an essential role in diabetic foot risk screening, yet the screening behaviors of general practitioners have rarely been studied in primary care settings. This study aimed to investigate foot risk screening behaviors and analyze their influencing factors among general practitioners. Methods A cross-sectional study was conducted among 844 general practitioners from 78 community health centers in Changsha, China. A self-designed and validated questionnaire was used to assess the general practitioner’s cognition, attitude, and behaviors on performing diabetic foot risk screening. Multivariate linear regression was conducted to investigate the influencing factors of risk screening behaviors. Results The average score of diabetic foot risk screening behaviors among the general practitioners was 61.53 ± 14.69, and 271 (32.1%) always or frequently performed foot risk screening for diabetic patients. Higher training frequency (β = 3.197, p < 0.001), higher screening cognition (β = 2.947, p < 0.001), and more positive screening attitude (β = 4.564, p < 0.001) were associated with more diabetic foot risk screening behaviors, while limited time and energy (β=-5.184, p < 0.001) and lack of screening tools (β=-6.226, p < 0.001) were associated with fewer diabetic foot screening behaviors. Conclusion The score of risk screening behaviors for the diabetic foot of general practitioners in Changsha was at a medium level. General practitioners’ diabetic foot risk screening behaviors may be improved through strengthening training on relevant guidelines and evidence-based screening techniques, improving cognition and attitude towards foot risk screening among general practitioners, provision of more general practitioners or nurse practitioners, and user-friendly screening tools.
Background Diabetic foot is a serious complication of diabetes with a high disability and mortality rate, which can be prevented by early screening. General practitioners play an essential role in diabetic foot screening, yet the screening behaviors of general practitioners have rarely been studied in primary care settings. This study aimed to investigate foot risk screening behaviors and analyze their influencing factors among general practitioners. Methods Using the convenience sampling method, a cross-sectional study was conducted among 844 general practitioners from 78 community health centers in Changsha, China. A self-designed and validated questionnaire was used to assess the general practitioner’s cognition, attitude, and behaviors on performing diabetic foot screening. Multivariate linear regression was conducted to investigate the influencing factors of screening behaviors. Results The average score of diabetic foot screening behaviors among the general practitioners was 61.53 ± 14.69, and 271 (32.1%) always or frequently performed foot screening for diabetic patients. Higher training frequency (β = 3.197, p < 0.001), higher screening cognition (β = 2.947, p < 0.001), and more positive screening attitude (β = 4.564, p < 0.001) were associated with more diabetic foot screening behaviors, while limited time and energy (β=-5.184, p < 0.001) and lack of screening tools (β=-6.226, p < 0.001) were associated with fewer diabetic foot screening behaviors. Conclusion The score of screening behaviors for the diabetic foot of general practitioners in Changsha was at a medium level. General practitioners’ diabetic foot screening behaviors may be improved through strengthening training on relevant guidelines and evidence-based screening techniques, improving cognition and attitude towards foot screening among general practitioners, provision of more general practitioners or nurse practitioners, and user-friendly screening tools.
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