Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.226
Filtrar
1.
Rev Prat ; 69(6): 616-619, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626416

RESUMO

The off-loading of diabetic foot ulcers is the most urgent and theoretically the easiest treatment to implement. Its effectiveness has been proven for decades by randomized controlled studies on neuropathic ulcers that heal with a cast in an average of 6 weeks with a high level of evidence. Total contact casts are not widely used throughout the world, although it is the standard treatment. Off-loading shoes are certainly effective but only if they are worn. It is the prescriber's challenge to obtain maximum compliance that makes it possible to avoid infections and secondary amputations that are totally avoidable most of the time and only related to the delay in optimal care, of which off loading is the essential part.


Assuntos
Pé Diabético , Suporte de Carga/fisiologia , Cicatrização , Amputação , Moldes Cirúrgicos , Pé Diabético/prevenção & controle , Pé Diabético/terapia , Humanos , Pressão , Sapatos
2.
Rev. cuba. angiol. cir. vasc ; 20(1)ene.-jun. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1042874

RESUMO

La prevención ha sido un objetivo perenne en la formación de los angiólogos y cirujanos vasculares cubanos. El lograr predecir y prevenir en las úlceras en los pacientes diabéticos, es un añorado éxito. En este texto, se hace una revisión conceptual de algunos aspectos relativos al tema, y a la vez recientes observaciones de investigadores, que nos dejan ver todas las nuevas posibilidades existentes de investigación en derredor de la prevención de la úlcera en el pie del paciente diabético(AU)


Prevention has been a perennial objective in the training of Cuban vascular surgeons and angiologists. Predicting and preventing ulcers in diabetic patients is a desired success. In this text, a conceptual review of some aspects related to this subject is made, and at the same time of recent observations of researchers, which allow us to see all the new possibilities of research on the prevention of foot ulcer in diabetic patients(AU)


Assuntos
Pé Diabético/prevenção & controle , Diabetes Mellitus , Cuba
3.
Diabetes Res Clin Pract ; 152: 29-38, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31082445

RESUMO

AIMS: To evaluate the effectiveness of a theory-based foot care education intervention program (3STEPFUN) for people with type 2 diabetes at low risk of developing a foot ulcer. METHODS: A controlled, pre-test/ post-test quasi-experimental design was used. From 119 participants, 60 participants in the control group received usual care and a foot care brochure. Those in the intervention group received (1) a small group intensive education and hands-on skills session; (2) a foot care kit and documents; and (3) three regular booster follow-up phone calls over 6 months. Generalised Estimating Equations models were undertaken to examine the impact of the intervention on outcomes over time. RESULTS: The intervention group had significantly improved outcomes compared to the control group over 6 months in the following aspects: improved preventive foot care behaviour (p = 0.001); and decreased prevalence of foot risk factors for ulceration (i.e. dry skin, corns/ callus) (OR: 0.04, 95% CI 0.01 - 0.13, p < 0.001). CONCLUSIONS: The study's findings provide evidence of 3STEPFUN on improving foot self-care behaviour and preventing minor foot problems. Further study with formal RCT design and longer follow-up time to examine the effects on decreasing foot ulcer incidence is recommended.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Pé Diabético/prevenção & controle , Comportamentos Relacionados com a Saúde , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Idoso , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Pé/patologia , Comportamentos Relacionados com a Saúde/fisiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Método Simples-Cego
4.
Clin Podiatr Med Surg ; 36(3): 355-359, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079602

RESUMO

Diabetes mellitus is an international epidemic. In the United States, the prevalence of diabetes has increased from estimates in 1990 when 6.5% of the population was affected and 6.2 million people had diabetes compared with the estimates in 2017 with 24.7 million people with diabetes or accounting 9.6% of the adult population. The diabetic foot syndrome manifests as a combination of diabetes-related diseases including diabetic sensory neuropathy, limited joint mobility, immunopathy, peripheral arterial disease, foot ulceration, and Charcot arthropathy. The culmination of these provides an ideal environment for unrecognized tissue injury that leads to ulceration, infection, infection, and amputation.


Assuntos
Diabetes Mellitus/epidemiologia , Pé Diabético/prevenção & controle , Amputação/estatística & dados numéricos , Diabetes Mellitus/economia , Pé Diabético/complicações , Neuropatias Diabéticas/complicações , Humanos , Equipe de Assistência ao Paciente , Prevalência , Estados Unidos/epidemiologia
5.
Clin Podiatr Med Surg ; 36(3): 371-379, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079604

RESUMO

The etiology of ulcerations in diabetes mellitus is associated with the presence of peripheral sensory neuropathy and repetitive trauma due to normal walking activities to areas on the foot that are subject to moderate or high pressures and shear. The combination of loss of protective sensation, deformity, and repetitive trauma is the perfect storm for ulcer development. Once an ulcer is developed, the most important part of the healing process is offloading the ulcer site. Offloading is the mainstay of healing neuropathic ulcers.


Assuntos
Pé Diabético/prevenção & controle , Órtoses do Pé , Sapatos , Pé Diabético/etiologia , Neuropatias Diabéticas/complicações , Desenho de Equipamento , Humanos
6.
Diabetes Res Clin Pract ; 154: 66-74, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31128134

RESUMO

AIMS: Incorrectly fitting shoes are implicated in callus formation and a significant proportion of diabetic foot ulcers, yet remain surprisingly prevalent. We review the current shoe fit guidelines for consistency and discuss ways in which technology may assist us in standardising methods of footwear assessment. METHODS: Narrative review. RESULTS: Incorrectly fitted shoes are implicated in the development of some diabetic foot ulcers yet surprisingly there's no consensus on shoe fit, despite substantial spending on prescription footwear. Suggested toe gaps vary from 6 to 20 mm and measurement methods also vary from Brannock Devices and callipers to manual measurement. CONCLUSIONS: To prevent fit-related foot ulceration, we need to standardise our biomechanical definition of fit. Future research should (1) evaluate the potential use of 3D scanning technology to provide a standardised means of capturing foot morphology; (2) develop a working biomechanical definition of fit, including toe gap through the identification of key physiological markers that capture and predict dynamic foot shape changes during different physical activities and body weight loading conditions; and (3) determine whether changes in dynamic foot shape of those with diabetes differs from those without, impacting on their shoe fitting needs, potentially necessitating specialist footwear at an earlier stage to avoid ulceration.


Assuntos
Pé Diabético/prevenção & controle , Pé/anatomia & histologia , Sapatos/normas , Pesos e Medidas Corporais , Pé/fisiologia , Humanos
7.
J Foot Ankle Res ; 12: 17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30923577

RESUMO

Background: Aboriginal and Torres Islander Australians experience considerably higher rates of diabetes and diabetes related foot complications and amputations than non-Indigenous Australians. Therefore there is a need to identify aspects of Aboriginal and Torres Islander focussed foot health programs that have had successful outcomes in reducing diabetes related foot complications. Wider knowledge and implementation of these programs may help reduce the high burden of diabetes related foot disease experienced by Aboriginal and Torres Islander Australians. Methods: PubMeD, Informit Indigenous collection, CINAHL, SCOPUS, the Cochrane Library and grey literature sources were searched to 28th August 2018. We included any published reports or studies of stand-alone diabetes related foot care interventions, programs, services, educational resources or assessment of these interventions, designed for Aboriginal and Torres Strait Islander Australians. Results: Thirteen studies detailing interventions in the Northern Territory, New South Wales, Queensland and Western Australia met the inclusion criteria. Five reports described delivery of podiatry services while the other eight investigated educational and training programs. Half of the reports related to aspects of the Indigenous Diabetic Foot program which provides culturally appropriate foot education and training workshops for health care providers. One article reported quantitative data related to clinical patient outcome measures. Conclusions: No state- or nation-wide foot health programs for prevention of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians were identified. One program achieved high adherence to the national guidelines regarding timing of podiatry review treatments through use of an evidence based foot risk classification tool and provision of services in a culturally appropriate centre.


Assuntos
Pé Diabético/etnologia , Pé Diabético/prevenção & controle , Acesso aos Serviços de Saúde/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Podiatria/organização & administração , Austrália/epidemiologia , Assistência à Saúde/organização & administração , Humanos , Grupo com Ancestrais Oceânicos/educação , Educação de Pacientes como Assunto/organização & administração , Serviços Preventivos de Saúde/organização & administração
8.
PLoS One ; 14(2): e0211140, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30789920

RESUMO

BACKGROUND: Few studies have investigated if people at risk of foot ulceration actually wear the footwear recommended by best practice guidelines to prevent foot ulceration. This study aimed to investigate the prevalence of, and factors associated with, wearing inadequate outdoor footwear in those with diabetes or peripheral neuropathy in an inpatient population. METHODS: This was a secondary analysis of a multi-site cross-sectional study investigating foot conditions in a large representative inpatient population admitted into hospital for any medical reason on one day. A range of explanatory variables were collected from all participants including sociodemographic, medical and foot condition factors. The outcome variable for this study was the self-reported outdoor footwear type worn most by participants outside the house in the year prior to hospitalisation. The self-reported footwear type was then categorised into adequate and inadequate according to footwear features recommended in guidelines for populations at risk of foot ulceration. Logistic regression identified factors independently associated with inadequate footwear in all inpatient participants, and diabetes and neuropathy subgroups. RESULTS: Overall, 47% of a total of 726 inpatients wore inadequate outdoor footwear; 49% of the 171 in the diabetes subgroup and 43% of 159 in the neuropathy subgroup. Wearing inadequate outdoor footwear was independently associated (Odds Ratio (95% Confidence Interval)) with being female in the diabetes (2.7 (1.4-5.2)) and neuropathy subgroups (3.7 (1.8-7.9)) and being female (5.1 (3.7-7.1)), having critical peripheral arterial disease (2.5 (1.1-5.9)) and an amputation (0.3 (0.1-0.7)) in all inpatients (all, p<0.05). CONCLUSIONS: Almost half of all inpatients at risk of foot ulceration reported wearing outdoor footwear most of the time that did not meet recommendations for prevention. We found women were much more likely to wear inadequate footwear. More work needs to be done to increase the uptake of footwear recommendations in these populations to prevent foot ulceration.


Assuntos
Úlcera do Pé/etiologia , Úlcera do Pé/prevenção & controle , Sapatos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Pé Diabético/etiologia , Pé Diabético/prevenção & controle , Feminino , Humanos , Pacientes Internados , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/complicações , Queensland , Fatores de Risco , Autorrelato , Sapatos/efeitos adversos , Sapatos/normas
9.
J Foot Ankle Res ; 12: 2, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30636974

RESUMO

Background: Diabetic foot ulceration is a considerable cost to the NHS and foot orthotic provision is a core strategy for the management of the people with diabetes and a moderate to high risk of foot ulceration. The traditional process to produce a custom-made foot orthotic device is to use manual casting of foot shape and physical moulding of orthoses materials. Parts of this process can be undertaken using digital tools rather than manual processes with potential advantages. The aim of this trial was to provide the first comparison of a traditional orthoses supply chain to a digital supply chain over a 6 month period. The trial used plantar pressure, health status, and health service time and cost data to compare the two supply chains. Methods: Fifty-seven participants with diabetes were randomly allocated to each supply chain. Plantar pressure data and health status (EQ5D, ICECAP) was assessed at point of supply and at six-months. The costs for orthoses and clinical services accessed by participants were assessed over the 6 months of the trial. Primary outcomes were: reduction in peak plantar pressure at the site of highest pressure, assessed for non-inferiority to current care. Secondary outcomes were: reduction in plantar pressure at foot regions identified as at risk (> 200 kPa), cost-consequence analysis (supply chain, clinician time, service use) and health status. Results: At point of supply pressure reduction for the digital supply chain was non-inferior to a predefined margin and superior (p < 0.1) to the traditional supply chain, but both supply chains were inferior to the margin after 6 months. Custom-made orthoses significantly reduced pressure for at risk regions compared to a flat control (traditional - 13.85%, digital - 20.52%). The digital supply chain was more expensive (+£13.17) and required more clinician time (+ 35 min). There were no significant differences in health status or service use between supply chains. Conclusions: Custom made foot orthoses reduce pressure as expected. Given some assumptions about the cost models we used, the supply chain process adopted to produce the orthoses seems to have marginal impact on overall costs and health status. Trial registration: Retrospectively registered on ISRCTN registry (ISRCTN10978940, 04/11/2015).


Assuntos
Pé Diabético/prevenção & controle , Órtoses do Pé , Adulto , Idoso , Idoso de 80 Anos ou mais , Pé Diabético/economia , Feminino , Órtoses do Pé/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Desenho de Prótese/métodos , Qualidade de Vida , Sapatos , Medicina Estatal/economia
11.
Diabetes Metab Syndr ; 13(1): 78-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641806

RESUMO

OBJECTIVE: To assess the role of ABI and TBI in the detection of ulcer wounds among diabetic patients. METHODS: A retrospective approach is used to enroll 192 diabetic patients to detect their ulcer wounds using ABI and TBI index. HbA1c and lipid profile were other important variables in determining the efficacy of screening test. Frequency analysis and Pearson Correlation were used to analyze the data through SPSS. FINDINGS: The results have shown that 57.1% male and 42.9% female were treated in <0.60 ABI group; 67.4% male and 32.6% female were treated in 0.60-0.90 ABI group; 65.9% male and 34.1% female were treated in 0.90-1.30 ABI group; and 63.8% male and 36.2% female were treated in >1.30 ABI group. The correlation showed insignificant association between ABI and ulcer outcomes, but significant association between TBI and ulcer outcomes at 5% level of significance. CONCLUSION: The study concluded that ABI should be based on standardized normal values to be used as an effective biomarker in screening diabetic foot ulcer patients.


Assuntos
Índice Tornozelo-Braço , Pé Diabético/prevenção & controle , Dedos do Pé/irrigação sanguínea , Cicatrização , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Prognóstico , Estudos Retrospectivos
12.
Diabetes Metab Res Rev ; 35(2): e3105, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30513132

RESUMO

Diabetic foot ulceration is a major complication associated with high morbidity. Little evidence exists on which interventions are effective at preventing ulceration. Participants who are adherent to self-care behaviours have significantly better outcomes. Motivational interviewing is an intervention that has been used successfully for conditions where adherence is important, such as reduction of obesity and HbA1c levels. A systematic review was conducted to determine whether motivational interviewing is effective at improving adherence for the prevention of Diabetic Foot Ulceration. Electronic searches were run without date or language restrictions in MEDLINE (viaEBSCOhost), CINAHL (viaEBSCOhost), ProQuest (Health and Medical Collection, Nursing and Allied Health Database, PsycINFO, Psychology, PsychArticles), AMED, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect, and Web of Science Core Collections. Papers were included if participants had or were at risk of diabetic foot ulceration. Studies required motivational interviewing or a motivational approach as the sole intervention or as a component. Randomised controlled trials and quasi-experimental studies were included if ulceration and/or at least one behavioural outcome was measured before and after the intervention. Five studies met the inclusion criteria. Heterogeneity prevented the pooling of data. One study used motivational interviewing as the sole intervention. This study found a short-term positive effect on footwear adherence. The remaining four studies had a motivational component within their interventions. Two of these studies showed the intervention to be effective but both were at a high risk of bias. This review demonstrates an evidence gap. More research is needed.


Assuntos
Pé Diabético/prevenção & controle , Entrevista Motivacional/métodos , Cooperação do Paciente , Educação de Pacientes como Assunto , Autocuidado , Humanos
13.
Diabetes Metab Res Rev ; 35(2): e3101, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30468566

RESUMO

AIM: No studies have investigated if national guidelines to manage diabetic foot disease differ from international guidelines. This study aimed to compare guidelines of Western Pacific nations with the International Working Group on the Diabetic Foot (IWGDF) guidance documents. METHODS: The 77 recommendations in five chapters of the 2015 IWGDF guidance documents were used as the international gold standard reference. The IWGDF national representative(s) from 12 Western Pacific nations were invited to submit their nation's diabetic foot guideline(s). Four investigators rated information in the national guidelines as "similar," "partially similar," "not similar," or "different" when compared with IWGDF recommendations. National representative(s) reviewed findings. Disagreements in ratings were discussed until consensus agreement achieved. RESULTS: Eight of 12 nations (67%) responded: Australia, China, New Zealand, Taiwan, and Thailand provided national guidelines; Singapore provided the Association of Southeast Asian Nations guidelines; and Hong Kong and the Philippines advised no formal national diabetic foot guidelines existed. The six national guidelines included were 39% similar/partially similar, 58% not similar, and 2% different compared with the IWGDF recommendations. Within individual IWGDF chapters, the six national guidelines were similar/partially similar with 53% of recommendations for the IWGDF prevention chapter, 42% for wound healing, 40% for infection, 40% for peripheral artery disease, and 20% for offloading. CONCLUSIONS: National diabetic foot disease guidelines from a large and diverse region of the world showed limited similarity to recommendations made by international guidelines. Differences between recommendations may contribute to differences in national diabetic foot disease outcomes and burdens.


Assuntos
Pé Diabético/prevenção & controle , Medicina Baseada em Evidências , Agências Internacionais , Programas Nacionais de Saúde/normas , Guias de Prática Clínica como Assunto/normas , Adulto , Gerenciamento Clínico , Feminino , Humanos , Masculino
14.
Rev Gaucha Enferm ; 39: e20170230, 2018 Nov 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30517431

RESUMO

OBJECTIVES: Identify in patients with type 2 diabetes what changes in the feet would be associated with demographic, clinical, biochemical and treatment characteristics and which would increase the risk of mortality. METHODS: Retrospective longitudinal study evaluating the alterations in feet of outpatients attended at a nursing visit. Data from the clinical history and foot exam were collected from 918 medical records of a convenience sample. RESULTS: At 10 years, the cumulative mortality attributable to peripheral polyneuropathy was 44.7%, to peripheral artery disease was 71.7%, to both conditions were 62.4%, and to amputation was 67.6%. After multivariate analysis, duration of nursing follow-up remained as the only protective factor against death (p < 0.001). CONCLUSIONS: The risk of death in these patients decreased when they had consultations with a nurse educator. Ischemic feet, amputation, and coronary artery disease remained independent risk factors.


Assuntos
Diabetes Mellitus Tipo 2/mortalidade , Pé Diabético/mortalidade , Amputação/mortalidade , Doenças Cardiovasculares/mortalidade , Causas de Morte , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/enfermagem , Pé Diabético/prevenção & controle , Neuropatias Diabéticas/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pacientes Ambulatoriais , Educação de Pacientes como Assunto , Doença Arterial Periférica/mortalidade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Cicatrização
15.
Rev. cuba. endocrinol ; 29(3): 1-9, set.-dic. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-978396

RESUMO

El síndrome del pie diabético constituye una de las complicaciones crónicas más temidas de la diabetes mellitus. En cuanto a su tratamiento, lo ideal sería prevenir su aparición actuando sobre los factores de riesgo de la úlcera del pie diabético. Sin embargo, una vez que el síndrome está presente, se reconoce la importancia que tiene para garantizar la cura de la úlcera y evitar el agravamiento de esta complicación, incluida la amputación de miembros inferiores, instaurar un tratamiento integral que se extienda más allá de la atención podálica, encaminado tanto a educar y apoyar al paciente, como a lograr un control glucémico óptimo y a atender los factores de riesgo vascular. Acerca del tratamiento integral y ampliado del síndrome del pie diabético trata esta revisión(AU)


Diabetic foot syndrome is one of the most feared chronic complications of diabetes mellitus. In terms of its treatment, the ideal thing to do would be to prevent its appearance by acting upon the risk factors for diabetic foot ulceration. However, once the syndrome is present, comprehensive treatment should be applied which extends beyond podiatric care and is geared to educate and support patients as well as achieve optimal glycemic control and ensure attention to vascular risk factors, so as to make sure ulceration is healed, thus preventing the worsening of this complication, which might otherwise lead to lower limb amputation. The present review deals with the comprehensive broadened treatment of diabetic foot syndrome(AU)


Assuntos
Humanos , Fatores de Risco , Pé Diabético/complicações , Pé Diabético/prevenção & controle , Pé Diabético/terapia
16.
Rev. cuba. endocrinol ; 29(3): 1-9, set.-dic. 2018. ilus
Artigo em Espanhol | CUMED | ID: cum-73084

RESUMO

El síndrome del pie diabético constituye una de las complicaciones crónicas más temidas de la diabetes mellitus. En cuanto a su tratamiento, lo ideal sería prevenir su aparición actuando sobre los factores de riesgo de la úlcera del pie diabético. Sin embargo, una vez que el síndrome está presente, se reconoce la importancia que tiene para garantizar la cura de la úlcera y evitar el agravamiento de esta complicación, incluida la amputación de miembros inferiores, instaurar un tratamiento integral que se extienda más allá de la atención podálica, encaminado tanto a educar y apoyar al paciente, como a lograr un control glucémico óptimo y a atender los factores de riesgo vascular. Acerca del tratamiento integral y ampliado del síndrome del pie diabético trata esta revisión(AU)


Diabetic foot syndrome is one of the most feared chronic complications of diabetes mellitus. In terms of its treatment, the ideal thing to do would be to prevent its appearance by acting upon the risk factors for diabetic foot ulceration. However, once the syndrome is present, comprehensive treatment should be applied which extends beyond podiatric care and is geared to educate and support patients as well as achieve optimal glycemic control and ensure attention to vascular risk factors, so as to make sure ulceration is healed, thus preventing the worsening of this complication, which might otherwise lead to lower limb amputation. The present review deals with the comprehensive broadened treatment of diabetic foot syndrome(AU)


Assuntos
Humanos , Fatores de Risco , Pé Diabético/complicações , Pé Diabético/prevenção & controle , Pé Diabético/terapia
18.
J Wound Care ; 27(Sup11): 1-32, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30398395

RESUMO

FOREWORD: The Point Project is an initiative between the two organisations: D-Foot International and the International Federation of Podiatrists (FIP-IFP). Both organisations promote the role of evidence-based foot care for patients with and at risk of diabetes. This collaborative work highlights the podiatric skills needed in order to deliver comprehensive evidence-based care to patients with diabetic foot disease. The statements along with the relevant skills and behaviours are based upon the guidance documents produced by the International Working Group on the Diabetic Foot (IWGDF), thus meaning while this is a consensus document it is also evidence-based. Representatives from both organisations with a multidisciplinary membership met early in 2017 to discuss the different areas of practice and to define which skills and behaviours were required at different levels of practice. Using the TRIEpodD-document (UK) and IWGDF guidance as the basis for discussion, the team identified which knowledge, skills and behaviours could be considered podiatric in nature. Once identified as podiatric, we discussed at which level of podiatric practice they could apply. The members of the team came from a variety of locations which represented practice at the different levels. Following the initial meeting, further discussions took place via email in order to consolidate initial discussions and complete the document. Cognisant of the large volume of guidance in relation to all areas of practice, this document is aimed to assist clinicians by pointing them in the direction in which they need to develop services rather than being a set of rules which must be followed. The POINT team feels that this document supports clinicians globally on three levels: As a benchmarking tool for existing teams to critically reflect upon their practice and identify where quality improvements can be made As a tool for clinicians who wish to establish a diabetic foot team to highlight the skills needed in order to provide care across the breadth of diabetic foot practice highlighting the specific roles in which podiatrists can help For national and local decision makers, to identify which skills can be provided by podiatrists to promote the development of the profession. While this is a consensus relating to podiatric skills, the team is aware that, in the absence of podiatrists, skills will be provided by other health professionals. We support this practice and while such professionals can not be considered podiatrists, they are providing podiatric skills to the diabetic foot team. The delivery of the relevant skill to the patient is the important factor, not the health professional is delivering it. The development of this document is merely the first step to identifying areas where skills need to be developed. Both D-Foot and FIP-IFP are committed to developing podiatric skills further across the globe. The aims and objectives of the two organisations are mutually beneficial to those suffering from diabetic foot disease. People with diabetes deserve the best care that they can receive, irrespective of the resources available. By working together we have been able to identify the podiatric knowledge, skills and behaviours required to provide evidence-based care. The next step is to work together to ensure consistent delivery of these globally for the benefit of those suffering the debilitating consequences of diabetic foot disease.


Assuntos
Pé Diabético/prevenção & controle , Pé Diabético/terapia , Internacionalidade , Podiatria/organização & administração , Consenso , Saúde Global , Humanos , Agências Internacionais , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Cicatrização
19.
Sensors (Basel) ; 18(10)2018 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-30274209

RESUMO

Excessive pressure and shear stress while walking cause a risk of callus formation, which eventually causes foot ulcers in patients with diabetes mellitus. Callus under the second metatarsal head (MTH) has been associated with increased shear stress/pressure ratios (SPR). Callus under the fifth MTH has been associated with increased peak shear stress (PSS). The purpose of this study is to examine whether the effect of the suitable size and width of shoes prevents diabetic foot ulcers under the second and fifth MTH. We measured the pressure and shear stress by testing three kinds of sizes and two types of width of shoes. Significant difference was not observed in the SPR under the second MTH among different sizes of shoes. However, the pressure and shear stress were significantly lower when putting on shoes of fit size compared with larger sizes. The PSS under the fifth MTH was significantly smaller when putting on shoes of fit width compared with those of narrow width. Wearing shoes of fit size and width has the potential to prevent callus formation by reducing the pressure and shear stress constituting SPR under the second MTH and PSS under the fifth MTH.


Assuntos
Calosidades/prevenção & controle , Pé/anatomia & histologia , Ossos do Metatarso/anatomia & histologia , Sapatos/estatística & dados numéricos , Adulto , Pé Diabético/prevenção & controle , Feminino , Voluntários Saudáveis , Humanos , Pressão , Caminhada
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA