A 12-Week Supervised Exercise Therapy Program for Patients with Diabetic Foot Ulcers: Program Development and Preliminary Feasibility.

Exercise therapy helps improve glycaemic control and insulin sensitivity and may be relevant in treating patients with diabetic foot ulcers (DFUs). This study describes the development of a 12-week exercise therapy program for patients with DFUs and the preliminary feasibility of the program focusing on the program's inclusion, adherence, and safety. The development process is built on knowledge from a published systematic review on exercise for people with DFUs and a grounded theory study on the main concerns of people with DFUs regarding physical activity. The development involved doctors, wound care nurses, podiatrists, and feedback from patients and physical therapists using semi-structured interviews. The program was designed as a combination of aerobic and resistance training exercises. The aerobic exercise phase on the stationary bike of 30-minute duration was aimed at a moderate intensity. Resistance exercises were conducted with a 15-repetition maximum approach (four to five sets per trial) throughout the 12-week period. Three patients were included and received the exercise intervention. Except for recruitment and retention rates, acceptance levels were met for all other research progression criteria. Patients found the intervention relevant, wanted further guidance on continuing exercising, and would have liked the intervention closer to their home for example, a municipality setting. Although the exercise therapy program for patients with DFUs was developed in a thorough process with the inclusion of available evidence and the involvement of patients and other stakeholders conclusions on feasibility are limited due to the low recruitment rate. A reconsideration of the setting is needed in future exercise intervention studies.

An exercise program for people with severe peripheral neuropathy and diabetic foot ulcers - a case series on feasibility and safety.

Purpose: To examine a non-weightbearing exercise program for persons with severe peripheral neuropathy (PN) and a diabetic foot ulcer in terms of feasibility and safety.Materials and methods: Five men (mean (SD) age of 68.2 (7.1) years) with diabetes, severe peripheral neuropathy and an active foot ulcer, participated in a 10-week exercise program. Program adherence, patient satisfaction, healing of foot ulcers, adverse advents, ability to perform activities of daily life, and changes in muscle strength were assessed.Results: All participants completed the program with a session attendance from 85 to 95%, and with high satisfaction (≥9 points on a 10-point numeric rating scale). Only minor adverse events occurred, and ulcers were reduced for all participants, from a median of 1.9 (IQR, 1.1-7.3) cm2 to 0.0 (0.0-3.0) cm2. The distance on stationary bike was improved from a mean (SD) of 3.30 (1.1) to 5.36 (0.5) kilometers, and strength training loads were progressed. Ability to perform in self-selected activities of daily living improved from a median of 4.3 (2-5) to 6.7 (5-8) on the Patient Specific Functional Scale (0-10 points), while maximal isometric knee-extension muscle strength improved with 23%.Conclusions: A non-weightbearing exercise program for people with diabetes, severe peripheral neuropathy and foot ulcers seems feasible and safe. Further studies are needed to confirm these findings.Implications for rehabilitationAn exercise program designed for people with severe peripheral neuropathy and diabetic foot ulcers can be safe by means of not compromising healing of foot ulcers.Feasible in terms of attendance and progression.An alternative to passive waiting for ulcer to heal in a population already deconditioned.

Emergent coordination and situated learning in a Hybrid OR: The mixed blessing of using radiation.

Mobilising knowledge and coordinating actions in order to make use of new innovations and technologies is a major challenge in the health care sector. Drawing upon a longitudinal, qualitative study of a Hybrid Operating Room in Sweden, we illustrate how the staff from a variety of medical specialties need to coordinate their tasks and competencies, and learn how to use the technology in a safe way. This study shows that learning across highly-professionalized communities is a recursive process of emergent coordination and situated learning, which includes the acknowledgement of others' expertise, task interdependence, and the pragmatic accommodation of latitude and control. Moreover, there was continuous negotiations between the different communities about what should constitute approved practice based on the task being performed. This obstructed the development of a dominant community with the authority to independently exclude other communities. We thus conclude that emergent coordination of tasks and expertise is an important aspect of learning how to use technologies that break with conventions of established and previously separated practices.

Performing boundary work: The emergence of a new practice in a hybrid operating room.

This paper addresses the processes of boundary work, in relation to the introduction of new technology, unfolding during the emergence of new medical practices. Inspired by Gieryn's fluid and practical view of boundaries and boundary work, and by Actor-Network Theory's description of scripting processes, we study the processes of negotiating and (re-)constructing boundaries in order to reveal both the interactions between different kinds of boundary work and their situatedness in the context of the emerging practice. We conducted a longitudinal and qualitative study of a generic Hybrid Operating Room at a Swedish university hospital, where sophisticated imaging devices are combined with open surgery procedures in a single room; consequently, medical requirements regarding radiology, surgery and anesthesia, as well as the specificities of the new technology, all need to be met at the same time. The study shows how the visibility of boundaries is a result of as well as a condition for boundary work, how boundary work is a dynamic and iterative process, and how it unfolds in a recursive relationship between practice and boundaries.

Powerless positions, silenced voices? - critical views on health and social care management.

PURPOSE: The purpose of this paper is to provide background to this special issue and consider how critically oriented research can be applied to health and social care management. DESIGN/METHODOLOGY/APPROACH: Basic principles of critical management studies are introduced briefly to frame subsequent papers in this issue. FINDINGS: In order to identify the wicked problems and darker sides of the care field, there is a need to study things in alternative ways through critical lenses. Giving a voice to those in less powerful positions may result in redefinition and redesign of conventional roles and agency of patients, volunteers and professionals and call into question the taken-for-granted understanding of health and social care management. ORIGINALITY/VALUE: The special issue as a whole was designed to enhance critical approaches to the discussion in the field of health and social care. This editorial hopefully raises awareness of CMS and serves as an opening for further discussion on critical views in the research on management and organization in this field.

Curing a meagre health care system by lean methods--translating 'chains of care' in the Swedish health care sector.

The purpose of this article is to discuss what happens when work embedded in a 'meagre' organizational context is changed by lean production-related methods. The article is based on studies of seven lean production-inspired projects in the Swedish health care sector, a sector already poor due to organizational slack. The projects were directed to develop 'health care chains', an organizational concept regarded as a way to rationalize health care organizations as well as to develop them, i.e. increase productivity, quality from a customer perspective and quality of working conditions. The article analyses the projects from an interpretative perspective and discusses how modem management models with ambitions to concurrently rationalize and develop organizations--e.g. lean production and health care chains--are used in a 'meagre' organizational field. As an outcome, a model is presented that explores what is beyond simple imitations and unique translations of ideas when a new concept is implemented in local organizations.