Measuring sustainability in healthcare: an analysis of two systems providing insoles to patients with diabetes

Hellstrand, Stefan; Sundberg, Leif; Karlsson, Jón; Zügner, Roland; Tranberg, Roy; Tang, Ulla Hellstrand

doi:10.1007/s10668-020-00901-z

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…Summary of the literature: We found 5 RCTs [73][74][75][76][77] (Table 4), and 20 non-controlled studies. [78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] Given their difference in the exact nature of the experimental insoles and the differences in outcomes, a meta-analysis was not possible. Ulcer recurrence incidence was nonsignificantly lower when using shear reducing insoles, and significantly lower when using insoles with a cut-out at the metatarsal heads (Table 4).…”

Section: Evidence Statements (Certainty Of the Evidence)mentioning

confidence: 99%

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Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta‐analysis

Netten

Raspovic

Lavery

et al. 2023

Diabetes Metabolism Res

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AimsPrevention of foot ulcers in persons with diabetes is important to help reduce the substantial burden on both individual and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review and meta‐analysis is to assess the effectiveness of interventions to prevent foot ulcers in persons with diabetes who are at risk thereof.Materials and MethodsWe searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on preventative interventions. Both controlled and non‐controlled studies were eligible for selection. Two independent reviewers assessed risk of bias of controlled studies and extracted data. A meta‐analysis (using Mantel‐Haenszel's statistical method and random effect models) was done when >1 RCT was available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE.ResultsFrom the 19,349 records screened, 40 controlled studies (of which 33 were Randomised Controlled Trials [RCTs]) and 103 non‐controlled studies were included. We found moderate certainty evidence that temperature monitoring (5 RCTs; risk ratio [RR]: 0.51; 95% CI: 0.31–0.84) and pressure‐optimised therapeutic footwear or insoles (2 RCTs; RR: 0.62; 95% CI: 0.26–1.47) likely reduce the risk of plantar foot ulcer recurrence in people with diabetes at high risk. Further, we found low certainty evidence that structured education (5 RCTs; RR: 0.66; 95% CI: 0.37–1.19), therapeutic footwear (3 RCTs; RR: 0.53; 95% CI: 0.24–1.17), flexor tenotomy (1 RCT, 7 non‐controlled studies, no meta‐analysis), and integrated care (3 RCTs; RR: 0.78; 95% CI: 0.58–1.06) may reduce the risk of foot ulceration in people with diabetes at risk for foot ulceration.ConclusionsVarious interventions for persons with diabetes at risk for foot ulceration with evidence of effectiveness are available, including temperature monitoring (pressure‐optimised) therapeutic footwear, structured education, flexor tenotomy, and integrated foot care. With hardly any new intervention studies published in recent years, more effort to produce high‐quality RCTs is urgently needed to further improve the evidence base. This is especially relevant for educational and psychological interventions, for integrated care approaches for persons at high risk of ulceration, and for interventions specifically targeting persons at low‐to‐moderate risk of ulceration.

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Section: Evidence Statements (Certainty Of the Evidence)mentioning

confidence: 99%

“…Summary of the literature : We found 5 RCTs 73–77 (Table 4), and 20 non‐controlled studies 78–97 . Given their difference in the exact nature of the experimental insoles and the differences in outcomes, a meta‐analysis was not possible.…”

Section: Category 2: Footwear and Other Orthotic Interventionsmentioning

confidence: 99%

Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta‐analysis

Netten

Raspovic

Lavery

et al. 2023

Diabetes Metabolism Res

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“…In 2021, the total number of patients at risk of developing DFUs was estimated at 270 million globally Zügner et al Journal of Foot and Ankle Research (2022) 15:90 [2] and 250,000 in Sweden [3][4][5], given that 50% of the patients have peripheral neuropathy [6,7]. DFUs are associated with poor quality of life [8] and high costs; the annual cost/DFU has been estimated at 19,000 US$ (around 110,000 SEK) [9][10][11]. The prevention of DFUs is essential to preserve the quality of life of patients and reduce healthcare costs to society [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Experiences of using a digital tool, the D‐foot, in the screening of risk factors for diabetic foot ulcers

Zügner

Jarl

Sundberg³

et al. 2022

Journal of Foot and Ankle Research

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Background Individuals living with diabetes run an increased risk of developing diabetic foot ulcers (DFUs), leading to high costs to society and reduced quality of life for the individual. Regular screening is important to avoid complications. Aim To evaluate patients’ and clinicians’ experiences of using a digital tool, the D-Foot, in the screening of risk factors for developing DFUs. The secondary aims were to investigate whether patients had had their feet examined by a nurse or doctor during the past year, had been referred to podiatry and whether patients had received information about self-care. Methods A prospective study was carried out, comprising 90 patients with diabetes visiting a Department of Prosthetics and Orthotics (DPO). Two Certified Prosthetists and Orthotists (CPOs) were included, and they assessed foot status and the risk of developing DFUs with the D-Foot software, prior to prescribing footwear. The quality of services at the DPO was assessed by the patients using the Orthotics and Prosthetics Users’ Survey (OPUS). The CPOs answered the System Usability Scale (SUS) before and after the study to assess the usability of the D-Foot. Results No patient had risk grade 1. One (1%) patient had risk grade 2, 78 (87%) patients had risk grade 3 and 11 (12%) patients had risk grade 4. Patients reported high levels of satisfaction on eight of ten OPUS items and the two items with lower scores were not related to the use of the D-Foot. The two CPOs reported levels above the mean regarding usability both before (77.5 and 90) and after (70 and 97.5) using the D-Foot. Conclusions Patients expressed a high level of satisfaction with the services when their feet were examined with the D-Foot prior to the provision of footwear. The CPOs found that the D-Foot system was usable. Several comments were made by patients and CPOs and will support the future development and testing of the D-Foot. There is a need to increase referrals for preventive podiatry and improve information on self-care for patients at risk of DFUs. Trial registration ClinicalTrials.gov ID: NCT04054804.

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Bibliometric analysis of sustainability papers: Evidence from Environment, Development and sustainability

Ellili

2023

Environ Dev Sustain

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This study aims to highlight the current trends in the literature on sustainability by applying a bibliometric review of papers on sustainability published in Environment, Development and Sustainability . Bibliometric analysis is a quantitative approach to bibliographic materials that highlights the core theoretical and empirical research on a specific field. In addition, it allows the classification of previous studies. Previous bibliometric reviewers were limited to sustainability papers in specific industries, while this study considers all papers on sustainability to provide further insights on overall sustainability topics. The analysis was based on keyword cartography analysis, bibliometric authors’ citation analysis, bibliometric papers’ citation analysis, bibliometric references’ co-citation analysis, journals’ co-citation cartography, and qualitative content analysis. A total of 997 articles on sustainability were reviewed. Bibliometric analysis was performed using VOSviewer and content analysis was performed using WordStat. Six major clusters were identified: environmental sustainability, sustainable development, urban sustainability, ecological footprint, environment, and climate change. In addition, the results reveal that Environment, Development and Sustainability has increasingly experienced important growth in research papers and citations, reflecting its significant contribution to the sustainability research field. In addition, this study presents recommendations for future research opportunities in the field of sustainability. The findings of this study have implications for sustainability research, such as the assessment of environmental and social sustainability in multinational institutional contexts and across industries as well as the examination of the impact of environmental and social sustainability on different corporate aspects and decisions. This study is the only one to review the key topics on which papers published in Environment, Development and Sustainability are focused and can be largely used for sustainability practices. This study provides an overview of how the literature on sustainability has developed, as well as a summary of the most productive authors, along with countries, organizations, and journal sources. This offers an opportunity for future research to focus on this topic.

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Measuring sustainability in healthcare: an analysis of two systems providing insoles to patients with diabetes

Cited by 6 publications

References 21 publications

Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta‐analysis

Prevention of foot ulcers in persons with diabetes at risk of ulceration: A systematic review and meta‐analysis

Experiences of using a digital tool, the D‐foot, in the screening of risk factors for diabetic foot ulcers

Bibliometric analysis of sustainability papers: Evidence from Environment, Development and sustainability

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