Risk factors for reamputation in patients with diabetic foot: A case-control study.

BACKGROUND: Reamputation as a complication of diabetic foot ulcers presents a high economic burden and represents a therapeutic failure. It is paramount to identify as early as possible patients in whom a minor amputation may not be the best option. The purpose of this investigation was to do a case-controlled study to determine risk factors associated with re-amputation in patients with DFU (diabetic foot ulcers) at two University Hospitals. METHODS: Multicentric, observational, retrospective, case-control study from clinical records of 2 university hospitals. Our study included 420 patients, with 171 cases (re-amputations), and 249 controls. We performed a multivariate logistic regression analysis and time-to-event survival analysis to identify re-amputation risk factors. RESULTS: Statistically significant risk factors were artery history of tobacco use (p = 0.001); male sex (p = 0.048); arterial occlusion in Doppler ultrasound (p = 0.001); percentage of stenosis in arterial ultrasound >50 % (p = 0.053); requirement of vascular intervention (p = 0.01); and microvascular involvement in photoplethysmography (p = 0.033). The most parsimonious regression model suggests that history of tobacco use, male sex, arterial occlusion in ultrasound, and percentage of stenosis in arterial ultrasound >50 % remained statistically significant. The survival analysis identified earlier amputations in patients with larger occlusion in arterial ultrasound, high leukocyte count, and elevated ESR. CONCLUSION: Direct and surrogate outcomes in patients with diabetic foot ulcers identify vascular involvement as an important risk factor for reamputation. LEVEL OF EVIDENCE: III.

Conocimientos, actitudes y prácticas acerca de la medicina alternativa en médicos vinculados a hospitales públicos de Cundinamarca, Colombia / Knowledge, attitudes and practice concerning complementary and alternative medicine (CAM) amongst doctors working in public hospitals in Cundinamarca, Colombia

Objetivo: Identificar conocimientos, actitudes y practicas acerca de la medicina alternativa y complementaria en médicos vinculados a hospitales públicos en el departamento de Cundinamarca. Métodos: Se realizó un estudio cuantitativo observacional descriptivo. La población estuvo conformada por médicos generales y especialistas vinculados a los 37 hospitales públicos del departamento de Cundinamarca durante el periodo diciembre de 2009 a marzo 2010. La muestra incluyó a 280 médicos con un nivel de confianza del 95 % y error del 0,5 %. Resultados: Existe un desconocimiento para los sistemas médicos complejos del 93 % y para las terapéuticas de un 91 %. Sin embargo, el 41 % de los médicos entrevistados desea capacitarse formalmente en el área de medicina alternativa y complementaria (MAC) y el 15 % tiene alguna formación en esta área. El 18 % remiten a sus pacientes para tratamientos relacionados con MAC, el 25 % ha recibido tratamiento de MAC. La mitad de los médicos considera que se debe enseñar a los estudiantes de medicina sobre MAC. Conclusiones: Existe una tendencia positiva hacia la MAC de la experiencia y edad del médico. Además se considera que poseen una evidencia científica demostrable, por lo que desean recibir una educación formal en esta área. Existe una percepción de utilidad, uso y recomendación de estas medicinas tanto para su vida personal como en la práctica médica cotidiana, haciendo explicita la necesidad de acceso a las MAC a través del plan obligatorio de salud.

Objective: Identifying the knowledge, attitudes and practices of doctors working in public hospitals in the Cundinamarca department, Colombia, regarding complementary and alternative medicine. Methods: This was a descriptive, quantitative observational study. The target population consisted of general practitioners and specialists involved in the 37 public hospitals in the Cundinamarca department from December 2009 to March 2010. The sample included 280 doctors (using 95 % confidence level and 0.5% error). Results: There was 93 % misunderstanding of complex medical systems and 91 % regarding therapeutic systems. However, 41 % of the doctors surveyed wished to receive formal training in the area of complementary and alternative medicine (CAM) and 15 % had some training in this area. 18 % referred patients for CAM-related treatment and 25 % had received MAC treatment. Half of the doctors considered that CAM should be taught to medical students. 40 % considered that CAM should be included in the compulsory health plan in Colombia. Conclusions: A positive trend regarding CAM was related to a doctor's age and experience. It was also believed that demonstrable scientific evidence was available regarding CAM so they wished to receive formal education in this area. These drugs were perceived to be useful, in current use and recommended concerning their personal life and everyday medical practice, making explicit the need for access to MAC through the compulsory Colombian health plan.

[Knowledge, attitudes and practice concerning complementary and alternative medicine (CAM) amongst doctors working in public hospitals in Cundinamarca, Colombia]. / Conocimientos, actitudes y prácticas acerca de la medicina alternativa en médicos vinculados a hospitales públicos de Cundinamarca, Colombia.

OBJECTIVE: Identifying the knowledge, attitudes and practices of doctors working in public hospitals in the Cundinamarca department, Colombia, regarding complementary and alternative medicine. METHODS: This was a descriptive, quantitative observational study. The target population consisted of general practitioners and specialists involved in the 37 public hospitals in the Cundinamarca department from December 2009 to March 2010. The sample included 280 doctors (using 95 % confidence level and 0.5% error). RESULTS: There was 93 % misunderstanding of complex medical systems and 91 % regarding therapeutic systems. However, 41 % of the doctors surveyed wished to receive formal training in the area of complementary and alternative medicine (CAM) and 15 % had some training in this area. 18 % referred patients for CAM-related treatment and 25 % had received MAC treatment. Half of the doctors considered that CAM should be taught to medical students. 40 % considered that CAM should be included in the compulsory health plan in Colombia. CONCLUSIONS: A positive trend regarding CAM was related to a doctor's age and experience. It was also believed that demonstrable scientific evidence was available regarding CAM so they wished to receive formal education in this area. These drugs were perceived to be useful, in current use and recommended concerning their personal life and everyday medical practice, making explicit the need for access to MAC through the compulsory Colombian health plan.