Lower resource utilization for patients with healed diabetic foot ulcers during participation in a prevention program with foot temperature monitoring.

INTRODUCTION: We assessed the impact of a diabetic foot ulcer prevention program incorporating once-daily foot temperature monitoring on hospitalizations, emergency department and outpatient visits, and rates of diabetic foot ulcer recurrence and lower extremity amputations for patients with recently healed foot ulcers. RESEARCH DESIGN AND METHODS: In this retrospective analysis of real-world data, we enrolled 80 participants with a healed diabetic foot ulcer in a year-long foot ulcer recurrence prevention program. Four outpatient centers within a large integrated healthcare system in the USA contributed to enrollment. We evaluated diabetic foot-related outcomes and associated resource utilization for participants during three periods: the 2 years before the program, the year during the program, and after the program ended. We reported unadjusted resource utilization rates during the program and the periods before and after it. We then adjusted rates of outcomes in each phase using an interrupted time series approach, explicitly controlling for overall trends in resource utilization and recurrence during the three periods. RESULTS: Our unadjusted data showed high initial rates of resource utilization and recurrence before enrollment in the program, followed by lower rates during the program, and higher rates of resource utilization and similar rates of recurrence in the period following the end of the program. The adjusted data showed lower rates of hospitalizations (relative risk reduction (RRR)=0.52; number needed to treat (NNT)=3.4), lower extremity amputations (RRR=0.71; NNT=6.4), and outpatient visits (RRR=0.26; absolute risk reduction (ARR)=3.5) during the program. We also found lower rates of foot ulcer recurrence during the program in the adjusted data, particularly for wounds with infection or greater than superficial depth (RRR=0.91; NNT=4.4). CONCLUSIONS: We observed lower rates of healthcare resource utilization for high-risk participants during enrollment in a diabetic foot prevention program incorporating once-daily foot temperature monitoring. TRIAL REGISTRATION NUMBER: NCT04345016.

[Psychotherapeutic day treatment of patients with severe personality disorders. Results from the first two years]. / Psykoterapeutisk dagbehandling af svaert personlighedsforstyrrede patienter. En toårsopgørelse.

INTRODUCTION: A psychotherapeutic day treatment (DT) for patients with severe personality disorders (PD) was established in January 2003, consisting of five months of intensive psychodynamic based integrated therapy for 14 patients. This paper presents results from the first two years. MATERIAL AND METHODS: 53 patients were included in a five month combined group psychotherapeutic DT, including psychoeducation, cognitive, body, music/drawing and individual therapy. Semi-structured interviews were used to assess diagnosis (PSE, SCID-II). SCL-90-R, self-rating scales and GAF rating (s/f) were used before and after therapy. The design was naturalistic. RESULTS: 40 patients (34 women) completed the DT. Eight dropped out and five received another treatment. Before treatment: Average age 27(SD 6,5), mean GAF= 43 corresponding with unemployment, singles and social dysfunctions, high degree of self mutilation, suicide attempts, earlier hospitalisations and substance abuse. The most frequent diagnosis was borderline disorder 63%. There were co-morbidity with anxiety disorder 48% and depression 22%. Most importantly, we found a significant reduction in symptoms, significant increase in the level of function, reduction in self destructive behaviour, a pronounced reduction in hospitalisations and a relatively high degree of satisfaction with the treatment programme. CONCLUSION: According to literature, effective treatment of patients with severe PD has to be long term, integrated, theoretical coherent and focused on compliance. Our study indicates that the intensive DT is effective and a good introduction to long term psychotherapy.