Management of diabetic foot disease and amputation in the Irish health system: a qualitative study of patients' attitudes and experiences with health services.

BACKGROUND: Diabetes is an increasingly prevalent chronic illness that places a huge burden on the individual, the health system and society. Patients with active foot disease and lower limb amputations due to diabetes have a significant amount of interaction with the health care services. The purpose of this study was to explore the attitudes and experiences of foot care services in Ireland among people with diabetes and active foot disease or lower limb amputations. METHODS: A purposive sample of individuals who had either active foot disease or a lower limb amputation as a result of diabetes were recruited from the Prosthetic, Orthotic and Limb Absence Rehabilitation (POLAR) Unit of an Irish hospital. One-to-one interviews were conducted in the POLAR unit using a semi-structured topic guide. Thematic analysis was used to identify, analyse and describe patterns within the data. RESULTS: Ten males participated in the study. Most participants expressed a need for emotional support alongside the medical management of their condition. There were substantial differences between participants with regard to the level of education and information they appeared to have received regarding their illness. There were also variations in levels of service received. Transport and medication costs were considered barriers. Having a medical card, which entitles the holder to free medical care, eased the burden of the patient's illness. A number of participants attributed some of the problems they faced with services to the health care system as a whole rather than health care professionals. CONCLUSION: Results suggest that rehabilitation services should place a strong focus on psychological as well as physical adjustment to active foot disease or lower limb amputations. The delivery of services needs to be standardised to ensure equal access to medical care and supplies among people with or at risk of lower extremity amputations. The wider social circumstances of patients should be taken into consideration by health care professionals to provide effective support while patients adjust to this potentially life changing complication. The patient's perspective should also be used to inform health service managers and health professionals on ways to improve services.

Measuring caffeine-induced changes in middle cerebral artery blood velocity using transcranial Doppler in patients recovering from ischaemic stroke.

Acute ingestion of caffeine is known to reduce cerebral blood flow in normal volunteers and in certain patient groups. There is no evidence that this causes problems in the normal population. However, there may be implications if a similar reduction occurs in patients recovering from an ischaemic stroke, in whom local blood flow has already been reduced. Transcranial Doppler provides a non-invasive method for measuring changes in middle cerebral artery (mca) blood velocity. A method for obtaining consistent. reliable measurements was developed and used in a double blind, randomized, crossover study on 20 patients (18 M, 2 F; mean age 70) recovering from ischaemic stroke in the mca territory. Middle cerebral artery blood velocity was measured bilaterally using transcranial Doppler before and after 250 mg caffeine (equivalent to about two cups of filter coffee) or matched placebo. Caffeine caused an average 12% reduction in blood velocity compared to placebo in the hemisphere affected by the stroke (95%c CI 8%-16%, p < 0.00001), and a 12% reduction in the non-affected hemisphere (95% CI 6%-18%, p < 0.001). The clinical implications are unclear at present, and imaging techniques will be required to establish whether caffeine does reduce flow to hypo-perfused regions.