Is the Combination of Plain X-ray and Probe-to-Bone Test Useful for Diagnosing Diabetic Foot Osteomyelitis? A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis was conducted to assess the diagnostic accuracy of the combination of plain X-ray and probe-to-bone (PTB) test for diagnosing diabetic foot osteomyelitis (DFO). This systematic review has been registered in PROSPERO (a prospective international register of systematic reviews; identification code CRD42023436757). A literature search was conducted for each test separately along with a third search for their combination. A total of 18 articles were found and divided into three groups for separate analysis and comparison. All selected studies were evaluated using STROBE guidelines to assess the quality of reporting for observational studies. Meta-DiSc software was used to analyze the collected data. Concerning the diagnostic accuracy variables for each case, the pooled sensitivity (SEN) was higher for the combination of PTB and plain X-ray [0.94 (PTB + X-ray) vs. 0.91 (PTB) vs. 0.76 (X-ray)], as was the diagnostic odds ratio (DOR) (82.212 (PTB + X-ray) vs. 57.444 (PTB) vs. 4.897 (X-ray)). The specificity (SPE) and positive likelihood ratio (LR+) were equally satisfactory for the diagnostic combination but somewhat lower than for PTB alone (SPE: 0.83 (PTB + X-ray) vs. 0.86 (PTB) vs. 0.76 (X-ray); LR+: 5.684 (PTB + X-ray) vs. 6.344 (PTB) vs. 1.969 (X-ray)). The combination of PTB and plain X-ray showed high diagnostic accuracy comparable to that of MRI and histopathology diagnosis (the gold standard), so it could be considered useful for the diagnosis of DFO. In addition, this diagnostic combination is accessible and inexpensive but requires training and experience to correctly interpret the results. Therefore, recommendations for this technique should be included in the context of specialized units with a high prevalence of DFO.

Effectiveness of Percutaneous Flexor Tenotomies for the Prevention and Management of Toe-Related Diabetic Foot Ulcers: A Systematic Review.

There is a high prevalence of digital deformities in diabetic patients, particularly claw toe, which can result in ulceration, often located at the tip of the toe. These lesions are challenging to off-load with conventional devices and frequently lead to infection and high amputation rates. Recent guidelines recommend considering flexor tenotomies to manage these ulcerations and prevent complications. This review, which analyzed 11 studies, aimed to assess the effect of flexor tenotomies on the healing and prevention of diabetic foot ulcers (DFUs) at the toe tip. Satisfactory results were found, with a healing rate of 92% to 100% and a mean healing time of 2-4 weeks. Few mild complications were observed, and the recurrence rate was very low. Transfer lesions were the most prevalent, but simultaneous tenotomy of all toes can eliminate this risk. Flexor tenotomies are a simple, effective, and safe procedure for the treatment and management of DFUs located at the apex of the toes and should be considered part of the standard of care for diabetic feet.

Shared Decision-Making for Drug-Drug Interactions: Formative Evaluation of an Anticoagulant Drug Interaction.

BACKGROUND: Warnings about drug-drug interactions (DDIs) between warfarin and nonsteroidal anti-inflammatory drugs (NSAIDs) within electronic health records indicate potential harm but fail to account for contextual factors and preferences. We developed a tool called DDInteract to enhance and support shared decision-making (SDM) between patients and physicians when both warfarin and NSAIDs are used concurrently. DDInteract was designed to be integrated into electronic health records using interoperability standards. OBJECTIVE: The purpose of this study was to conduct a formative evaluation of a DDInteract that incorporates patient and product contextual factors to estimate the risk of bleeding. METHODS: A randomized formative evaluation was conducted to compare DDInteract to usual care (UC) using physician-patient dyads. Using case vignettes, physicians and patients on warfarin participated in simulated virtual clinical encounters where they discussed the use of taking ibuprofen and warfarin concurrently and determined an appropriate therapeutic plan based on the patient's individualized risk. Dyads were randomized to either DDInteract or UC. Participants completed a postsession interview and survey of the SDM process. This included the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), tool usability and workload National Aeronautics and Space Administration (NASA) Task Load Index, Unified Theory of Acceptance and Use of Technology (UTAUT), Perceived Behavioral Control (PBC) scale, System Usability Scale (SUS), and Decision Conflict Scale (DCS). They also were interviewed after the session to obtain perceptions on DDInteract and UC resources for DDIs. RESULTS: Twelve dyad encounters were performed using virtual software. Most (n=11, 91.7%) patients were over 50 years of age, and 9 (75%) had been taking warfarin for more than 2 years (75%). Regarding scores on the SDM-Q-9, participants rated DDInteract higher than UC for questions pertaining to helping patients clarify the decision (P=.03), involving patients in the decision (P=.01), displaying treatment options (P<.001), identifying advantages and disadvantages (P=.01), and facilitating patient understanding (P=.01) and discussion of preferences (P=.01). Five of the 8 UTAUT constructs showed differences between the 2 groups, favoring DDInteract (P<.05). Usability ratings from the SUS were significantly higher (P<.05) for physicians using DDInteract compared to those in the UC group but showed no differences from the patient's perspective. No differences in patient responses were observed between groups using the DCS. During the session debrief, physicians indicated little concern for the additional time or workload entailed by DDInteract use. Both clinicians and patients indicated that the tool was beneficial in simulated encounters to understand and mitigate the risk of harm from this DDI. CONCLUSIONS: Overall, DDInteract may improve encounters where there is a risk of bleeding due to a potential drug-drug interaction involving anticoagulants. Participants rated DDInteract as logical and useful for enhancing SDM. They reported that they would be willing to use the tool for an interaction involving warfarin and NSAIDs.

Health advocacy and primary health care: evidence for nursing.

OBJECTIVES: to analyze nursing actions involving health advocacy in the context of primary health care and the consolidation of this right to health. METHODS: this is an integrative literature review with content analysis of the results on health advocacy and its relationship with nursing in the context of primary health care. RESULTS: the content analysis of the seven selected studies resulted in two thematic categories: "Right to health - a complex and progressive consolidation movement in Brazil" and "Advocacy in health and nursing". CONCLUSIONS: despite the difficulties in defining the concept of health advocacy, nurses, in their practice, act with innovative alternatives to daily conflicts, exercising the users' right to health in their relationships with health team members and the community.

[Perceived norm for marijuana use among university student peers]. / Norma percibida de consumo de marihuana en los pares de estudiantes universitarios.

UNLABELLED: This article describes the relationship between the perceived norm for marijuana use among peers and the use reported by university students in Chile. This is a qualitative, multicenter, cross-sectional study. A total 449 students participated with free consent. Data collection was performed using a self-administered questionnaire, and SPSS 15.0 was used for data analysis. RESULTS: most participants were women, single, between 20 and 21 years of age, students of nursing and education. The perceived norm is higher than reports from national studies (32.1% against 21%) and higher than the self-reported use (32.1% against 5.6%). Marijuana use is higher among women, in nursing and education courses. It was confirmed that marijuana use among women begins at the university; as it was used as a recreational drug and there was more tolerance among peers. It was observed that marijuana use was overestimated, which, according to the Theory of Social Norms and Normalization, has an effect on the increase of drug use. This study is a contribution for the country's and the university's policies.

[Perceived norms among nursing students about their peers and drug use in Lima, Peru]. / Normas percibidas por los estudiantes universitarios de enfermería acerca de sus pares y el uso de drogas en Lima, Perú

This quantitative, cross-sectional study was performed to estimate the difference between the perceived norms among university students, based on a survey of 196 nursing students from Lima, Peru. A questionnaire was used to measure the students' perception about drug use and their actual use. Descriptive statistical analysis was performed, considering a value greater, smaller or equal to 10 to establish the difference. The perceived norms for alcohol and tobacco were above 50%, against 6% for marijuana and cocaine; with 57.7% of participants reporting tobacco use, 84.7% alcohol, 2.6% marijuana and 1% cocaine. Marijuana and cocaine use was overestimated, while alcohol use was underestimated. The perception of tobacco use was correct. The study findings are useful to sensitize university authorities and put prevention policies in practice.

[Perceived norms among Peruvian students for drug use among peers]. / Normas percibidas por estudiantes peruanos acerca de sus pares y el uso de drogas.

OBJECTIVE: to evaluate the difference between perceived norms about drug use among peer and actual drug use as reported by the same university students. The students were between 18 and 24 years old and attended health courses. METHOD: cross-sectional study based on a survey, using an anonymous questionnaire filled out by the students. RESULTS: There were 306 participants. Senior students used drugs as follows: 51.3% used tobacco, 90.8% used alcohol, 5.9% used marijuana, and 0.7% used cocaine. Differences were observed between perceived norms and actual drug use for tobacco (70% vs. 51.3%), marijuana (10% vs. 5.9%) and cocaine (8.3% vs. 0.7%). CONCLUSIONS: university students presented an overestimated rate for the use of tobacco, marijuana and cocaine among their peers.

[Perceived norms among university students about their peers and drug use at a Chilean university]. / Normas percibidas por los estudiantes universitarios acerca de sus pares y uso de drogas en una universidad en Chile.

UNLABELLED: This study analyzes the relationship between perceived norms about drug use among peers and actual use among university students. This is a qualitative, multicenter study involving sophomore and junior students of the health courses of a Chilean university. Participants were 286 (75.2%) of the total 380 university students. RESULTS: more than 50% of the students notice that their peers smoke cigarettes on a daily basis, drink alcohol three times a week, and use marijuana once a week and cocaine at least once a year. The university campus it place of highest drug use; cocaine is used at a friend's house. Among students, 68% have smoked once in their life, 57% smoke on a daily basis; 88% have had alcohol once in their life; 26% used marijuana once in their life, 16% used marijuana over the last 12 months. Students do not know about any university policies for drug use. Some results confirm that drug use is underestimated.

[Use of illicit drugs and critical perspectives of drug users' relatives and acquaintances in Northern Rio de Janeiro City, Brazil]. / Uso de drogas ilícitas e perspectivas críticas de familiares e pessoas próximas, na cidade do Rio de Janeiro, Zona Norte, Brasil.

This article presents the partial results of a multicenter, qualitative study, which involved seven Latin-American countries and Canada. The results presented refer to Northern Rio de Janeiro (city), Brazil. The objective of the study was to describe the perspective of relatives/acquaintances of illicit drug users about protective and risk factors, prevention initiatives, treatment services, and legal aspects regarding illicit drugs. Interviews were performed with 99 individuals, who reported being affected by their relationship with an illicit drug user (relative or acquaintance), approaching their perspectives regarding the key-domains. Most participants were women (73.7%); relatives who used drugs were mostly men (78.2%); the most consumed drug was marijuana (77.8%). The highlighted protective factor was having recreational-sports activities in the community (88.9%), and the risk factor was curiosity for trying something new (94.4%). The main treatment services were Church Groups (51.5%), and participants stated that laws should be more punitive (82.8%). In conclusion, this information is essential to fight against drug use/abuse, showing that there is a need for actions that consider different perspectives at different levels.

[Family and acquaintances of illicit drug users: community perspectives on laws and public policies in Western Rio de Janeiro, Brazil]. / Familiares e pessoas conhecidas de usuários de drogas ilícitas: recorte de opiniões sobre leis e políticas públicas de uma comunidade da Zona Oeste do Rio de Janeiro, Brasil.

This article is part of the study 'Illicit Drug Use in Seven Latin American Countries and Canada: Critical Perspectives of Family and Familiars' (7LACC), which investigated four domains: protective and risk factors; preventive initiatives; treatment facilities; and laws and policies. The article presents a section of the results based on four items of the laws and policies domain--as perceived by the family and acquaintances of illicit drug users living in the community. Participants were recruited in urban primary health care units located in Western Rio de Janeiro (city), Brazil. This multi-method, cross-temporal study performed interviews with 100 adults (18 years of age or older), all cognitively healthy. Results and key conclusions included non-compliance with the fundamental principles of the Unique Health System Legislation / Law 8.080/90 and the erroneous implementation of laws and public policies on illicit drug.

[Illegal aspects of illicit drugs use in Mexico]. / Aspectos legales del uso de drogas ilícitas en México.

The objective of this cross-sectional, descriptive study was to obtain the opinions of a group of people about legal issues regarding addiction. Data collection was performed using a structured questionnaire with four themes. In order to participate, the individual could not use any drugs but should have a close relationship with a drug user. The data was processed using SPSS V. 14. There were 100 participants, 75% of whom were women, and 38% had a drug user as a friend, mainly cocaine and marijuana users. The participants had one opinion in common: laws should be more severe for people who use, sell, or transport drugs. The current laws do not improve consumers' criminal behavior. There is a need for further studies addressing people's opinion about this phenomenon in order to obtain a more realistic view of this drug issue.

[Critical perspective of the family and acquaintances on family and community risk factors in illicit drug use in São Jose, Costa Rica]. / Perspectiva crítica de la familia y de personas cercanas sobre factores de riesgo familiares y comunitarios en el uso de drogas ilícitas en San José, Costa Rica.

This article presents the results of a quantitative study. The purpose was to describe the perspective of family members and acquaintances of illicit drug users about family and community risk factors that can contribute to addiction to illicit drugs. A questionnaire was used for data collection. The population consisted of 100 individuals, 18 years of age or older, who reported being affected by their relationship with an illicit drug user (relative or acquaintance). Most users (82%) were men, with an average age of 27.3 years. Family risk factors included: family rejection (99%), not feeling loved (98%), lack of communication (95%), family conflicts and violence (95%). Social or community factors included: 99% having friends who use drugs, 99% peer pressure, 93% living in an unsafe area, and 99% experienced a stressful event. The critical perspective proposes to use more prevention strategies to avoid risk factors in the family and community.

[Risk factors related to the use of illegal drugs: the critical perspective of drug users' relatives and acquaintances at a public health center in San Pedro Sula, Honduras]. / Factores de riesgo relacionados al uso de drogas ilegales: perspectiva crítica de familiares y personas cercanas en un centro de salud público en San Pedro Sula, Honduras.

This article presents quantitative data from a multicenter, cross-sectional study, which was performed at a public health center in San Pedro Sula, Honduras, using multiple methods. The objective of the study was to describe the critical perspective of people who reported being affected by their relationship with an illicit drug user (relative or acquaintance) in terms of risk factors. Data collection was performed using 100 questionnaires. Most participants were women with low education levels. Drug users were mostly men, with an average age of 23.3 years. The most consumed drug was marijuana (78%), followed by crack/cocaine (72%), glue/inhalants (27%), hallucinogens (ecstasy/LSD) (3%), amphetamines/stimulants (1%), and heroin (1%). The identified risk factors include: previous experience with alcohol/tobacco, having friends who use drugs, lack of information, low self-esteem, age, and other personal, family and social factors. In conclusion, prevention and protection should be reinforced.

[Drug consumption and treatment from a family and friends perspectives: Guatemala]. / El consumo de drogas y su tratamiento desde la perspectiva de familiares y amigos de consumidores: Guatemala.

This quantitative and qualitative research describes the perspective of families and relatives of drug abusers in seven Latin American countries. In Guatemala, most of the people affected by the drug problem is multidrug abusers. Marijuana, followed by cocaine and benzodiazepines are the most used drugs. Of the respondents, 46% think drug use is a personal choice. They also recognize family as the most important protective factor, friends who use drugs and peer pressure are the major risk factors. The study reveals that the population believes that the response of the health services is insufficient, and that the preventive initiatives are not available or not properly addressed. The results show the need of more studies to update the knowledge of the drug problem in Guatemala. Future qualitative and quantitative research is needed to address the theme.

[Drug use and treatment from the perspective of the users' family and friends in Bogota, Colombia]. / El consumo de drogas y su tratamiento desde la perspectiva de familiares y amigos de consumidores en Bogotá, Colombia.

This article presents an analysis of the partial results from a quantitative study that addresses the perspective of drug users' family and friends regarding the treatment of problems resulting from the use of illicit drugs. Participants were 104 health service users in Bogotá. Of the participants, 58% consider that drug use is a disease that needs treatment; 56% stated the general hospital as the main alternative for treatment; 95% reported that the state accounted for this situation. Participants were more acquainted with private institutions, with therapeutic communities and religious groups being reported as the ones with the strongest commitment to the problem. For 73% of participants, the existing services are inappropriate and of difficult use and access. Stigma is the main barrier for a person to seek health care, and only 50% believe there is any use in treatments. There is a need for broader dissemination of the existing resources so as to increase their implementation and use.

[Perceived norms among Honduran university students about peers and tobacco, alcohol, marijuana and cocaine use]. / Normas percibidas por los estudiantes universitarios hondureños acerca de sus pares y el uso de tabaco, alcohol, marihuana y cocaína.

The purpose of this study was to assess the difference between perceived norms and peers' drug use among sophomore and junior university students (from the field of education) aged 18 to 24 years. The Social Norms Theory was used as the theoretical framework. In total, 286 students participated in the study, 67% of which reported having consumed alcohol at least once in a lifetime and 28% stated being daily users. Students perceived that 62% of their peers used tobacco and 63% used alcohol. The perceived norm for drug use was slightly higher in women than in men. In conclusion, there is an overestimation between the perceived norm and use of alcohol, tobacco, marijuana and cocaine.

[Critical perspective of relatives and acquaintances regarding protective factors and the use of illicit drugs in Guayaquil, Equador]. / Factores de protección relacionado al uso de drogas ilícitas: perspectiva crítica de familiares y personas cercanas a los usuarios de drogas, en la Ciudad de Guayaquil, Ecuador.

The objective of this study was to determine the perspectives of drug users' relatives and acquaintances about protective factors for illicit drug use at a health center in Guayaquil. This is a descriptive, cross-sectional study. Data collection was performed through interviews using a questionnaire. Interviews were performed with 100 people who knew a drug user (relative or friend). The results showed that the following personal and family factors could be protective: 97% having solid moral principles, 96% express their feelings, 98% dedicate time for the family, and 95 % have a supportive relationship with one of the parents. Regarding the community, all participants (100%) agree there is a need for a government that understands this issue, 99% refer there should be honest policemen, and 99% state the need for programs that protect people from drug use and institutions that work with prevention. Family, community and personal decisions have effects on becoming involved, hence the need to reinforce protective factors and thus reduce the number of addicted individuals.

[Laws and policies on illicit drugs in Brazil and the perspective of drug users' family members and acquaintances: a study in the City of Ribeirão Preto, São Paulo, Brazil]. / Políticas e leis sobre drogas ilícitas no Brasil e a perspectiva de familiares e pessoas próximas a usuários de drogas: estudo na Cidade de Ribeirão Preto, São Paulo, Brasil.

Brazilian drugs legislation has evolved from a prohibitionist system to a less repressive one in terms of drug users. The objective of this study was to identify the perception of relatives and acquaintances of drug users living in Ribeirão Preto, São Paulo, Brazil, about the country's laws and policies on drugs. Data collection was performed using a structured questionnaire. The sample consisted of 100 drug users' relatives or acquaintances, selected at a public health service. Respondents' relationships with the drug user were as follows: 31% friend, 23% sibling, 15% child and 7% spouse. Most users (78%) were men, with an average age of 26 years. Results confirm that national laws and policies have a direct effect on individuals' attitude and behaviors. There is a lack of trust in the police and a general perception that, despite recent chances that favor user rehabilitation, the laws on drugs do not respect users' human rights.

[University students' perception regarding drug use among peers in the ABC Region of São Paulo, Brazil]. / Percepção dos estudantes universitários sobre o consumo de drogas entre seus pares no ABC Paulista, São Paulo, Brasil.

This study aimed to analyze the relation between university students' perceived norms and actual drug use among their peers. This cross-sectional study was based on a survey. Evaluations involved all second- and third-year students (ages between 18 and 24 years) of the nursing and medicine courses at the Faculdade de Medicina do ABC, located in the city of Santo André, Brazil. Students were invited to answer a questionnaire that evaluated several variables, including their own drug use and their perception of their peers' drug use. In total, 274 students participated. Data analysis was performed using SPSS and descriptive techniques, including frequencies and means. There was an overestimation of the perception regarding drug use in relation to the actual frequency reported by the students.

[Illicit drug use and the critical perspectives of drug users' relatives and acquaintances in Northern Rio de Janeiro City, Brazil]. / Uso de drogas ilícitas e perspectivas críticas de familiares e pessoas próximas na cidade do Rio de Janeiro-Zona Norte, Brasil.

This article presents the partial results of a multicenter, cross-temporal study, which was performed using multiple methods, and involved seven Latin-American countries and Canada. The results presented refer to the city center of Rio de Janeiro (n=108). The central question of the study was: 'How do illicit drug users' relatives and acquaintances describe protective and risk factors, prevention initiatives, treatment services, laws and policies regarding illicit drugs?' The quantitative data was collected using an instrument containing closed questions. In total, 108 young adults (18 years of age or older) were interviewed, who stated being affected by the drug although they were not users. For 104 interviewees (96%), negligence is the family dynamics that causes the greatest exposure to drugs, and 106 (98%) consider that parent support is what offers the greatest protection. Policies, the police and the criminal system have neither reduced drug use nor do they protect users.