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Tu JF, Wang XZ, Yan SY, Wang YR, Yang JW, Shi GX, Zhang WZ, Jin LN, Yang LS, Liu DH, Wang LQ, Mi BH. Thermal sensitization of acupoints in patients with knee osteoarthritis: A cross-sectional case-control study. JOURNAL OF INTEGRATIVE MEDICINE 2025:S2095-4964(25)00041-X. [PMID: 40210574 DOI: 10.1016/j.joim.2025.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/06/2025] [Indexed: 04/12/2025]
Abstract
OBJECTIVE Varied acupoint selections represent a potential cause of the uncertainty surrounding the efficacy of acupuncture for knee osteoarthritis (OA). Skin temperature, a guiding factor for acupoint selection, may help to address this issue. This study explored thermal sensitization of acupoints used for the treatment of knee OA. METHODS This cross-sectional case-control study enrolled cases aged 45-75 years with symptomatic knee OA and age- and gender-matched non-knee OA controls in a 1:1 ratio. All participants underwent infrared thermographic imaging. The primary outcome was the relative skin temperature of acupoint (STA), and the secondary outcome was the absolute STA of 11 acupoints. The z test was used to compare the relative and absolute STAs between the groups. Principal component analysis was used to extract the common factors (CFs, acupoint cluster) in the STAs. A general linear model was used to identify factors affecting the STA in the knee OA cases. For the group comparisons of relative STA, P < 0.0045 (adjusted for 11 acupoints through Bonferroni correction) was considered to indicate statistical significance. For other analyses, P < 0.05 was used as the threshold for statistical significance. RESULTS The analysis included 308 participants, consisting of 151 cases (mean age: [64.58 ± 6.67] years; male: 25.83%; mean body mass index: [25.70 ± 3.16] kg/m2) and 157 controls (mean age: [63.37 ± 5.96] years; male: 26.11%; mean body mass index: [24.47 ± 2.84] kg/m2). The relative STAs of ST34 (P = 0.0001), EX-LE2 (P < 0.0001), EX-LE5 (P = 0.0006), SP10 (P < 0.0001), BL40 (P = 0.0012) and GB39 (P = 0.0037) were higher in the knee OA group. No difference was found in the STAs of ST35, ST36, SP9, GB33 and GB34. Four CFs were identified for relative STA in both groups. The acupoints within each CF were consistent between the groups. The mean values of the relative STAs across each CF were higher in the knee OA group. In the knee OA cases, no factors were observed to affect the relative STA, while age and gender were found to affect the absolute STA. CONCLUSION Among patients with knee OA, thermal sensitization occurs in the acupoints of the lower extremity, exhibiting localized and regional thermal consistencies. The thermally sensitized acupoints that we identified in this study, ST34, SP10, EX-LE2, EX-LE5, GB39 and BL40, may be good choices for the acupuncture treatment of knee OA. Please cite this article as: Tu JF, Wang XZ, Yan SY, Wang YR, Yang JW, Shi GX, Zhang WZ, Jing LN, Yang LS, Liu DH, Wang LQ, Mi BH. Thermal sensitization of acupoints in patients with knee osteoarthritis: A cross-sectional case-control study. J Integr Med. 2025; Epub ahead of print.
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Affiliation(s)
- Jian-Feng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xue-Zhou Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Shi-Yan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yi-Ran Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jing-Wen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Guang-Xia Shi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wen-Zheng Zhang
- International Medical Department, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100007, China
| | - Li-Na Jin
- Jiaodong Community Health Service Station, Beijing 100007, China
| | - Li-Sha Yang
- Xiaoguan East Street Community Health Service Station, Beijing 100029, China
| | - Dong-Hua Liu
- Deluyuan Community Health Service Station, Beijing 102300, China
| | - Li-Qiong Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Bao-Hong Mi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China; Engineering Research Center, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing 100029, China.
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Anggreni NKIS, Kristianto H, Handayani D, Yueniwati Y, Irawan PLT, Rosandi R, Kapti RE, Purnama AD. Artificial Intelligence for Diabetic Foot Screening Based on Digital Image Analysis: A Systematic Review. J Diabetes Sci Technol 2025:19322968251317521. [PMID: 39960227 PMCID: PMC11833800 DOI: 10.1177/19322968251317521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2025]
Abstract
INTRODUCTION Early detection of diabetic foot complications is essential for effective management and prevention of complications. Artificial intelligence (AI) technology based on digital image analysis offers a promising noninvasive method for diabetic foot screening. This systematic review aims to identify a study on the development of an AI model for diabetic foot screening using digital image analysis. METHODOLOGY The review scrutinized articles published between 2018 and 2023, sourced from PubMed, ProQuest, and ScienceDirect. The keyword-based search resulted in 2214 relevant articles and nine articles that met the inclusion criteria. The article quality assessment was done through Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Data were extracted and analyzed using NVivo. RESULTS Thermal imagery or foot thermogram was the main data source, with plantar temperature distribution patterns as an important indicator. Deep learning methods, specifically artificial neural networks (ANNs) and convolutional neural networks (CNNs), are the most commonly used methods. The highest performance is demonstrated by the ANN model with MATLAB's Image Processing Toolbox that is able to classify each type of macula with 97.5% accuracy. The findings show the great potential of AI in improving the accuracy and efficiency of diabetic foot screening. CONCLUSION This research provides important insights into the development of AI in digital image-based diabetic foot screening. Future studies need to focus on evaluating clinical applicability, including ethical aspects and patient data security, as well as developing more comprehensive data sets.
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Affiliation(s)
| | - Heri Kristianto
- Nursing Department, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
| | - Dian Handayani
- Nutrition Department, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
| | - Yuyun Yueniwati
- Radiology Department, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Paulus Lucky Tirma Irawan
- Informatics Engineering Department, Faculty of Technology and Design, Ma Chung University, Malang, Indonesia
| | - Rulli Rosandi
- Internal Medicine Department, Dr Saiful Anwar General Hospital, Malang, Indonesia
| | - Rinik Eko Kapti
- Nursing Department, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
| | - Avief Destian Purnama
- Nursing Department, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
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Jang J, Lee DW, Suh J, Shin J. Association of the COVID-19 Pandemic with HbA1c Testing and Complication Screening in Patients with Diabetes Mellitus. Yonsei Med J 2024; 65:669-676. [PMID: 39439171 PMCID: PMC11519130 DOI: 10.3349/ymj.2023.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 10/25/2024] Open
Abstract
PURPOSE This study aimed to identify the association between coronavirus disease 2019 (COVID-19) transmission levels and undergoing glycated hemoglobin (HbA1c) test and complication screenings among patients with diabetes mellitus. MATERIALS AND METHODS We included a total of 3601 diabetes patients' data from the 2020 Korean Community Health Survey to analyze the extent of the HbA1c testing and fundus examination, and 3592 diabetes patients' data to analyze kidney disease screening. COVID-19 transmission levels were classified into low transmission (Busan, Gwangju, Daejeon, Ulsan, and Sejong) and high transmission (Daegu, where the first large outbreak of COVID-19 occurred in Korea). Multiple logistic regression was used to obtain adjusted odds ratio (ORs) and 95% confidence interval (CI) to determine the association of COVID-19 transmission levels with undergoing HbA1c testing and diabetes complication screening. RESULTS The proportion of subjects who underwent complication screening of diabetes was lower in the high transmission region (low transmission vs. high transmission: 42.3% vs. 38.0% for fundus examination; 48.9% vs. 45.7% for kidney disease screening). A high COVID-19 transmission level was associated with decreased odds of undergoing fundus examination (OR, 0.82; 95% CI, 0.69-0.98) and kidney disease screening (OR, 0.76; 95% CI, 0.63-0.91). However, COVID-19 transmission levels were not significantly associated with undergoing HbA1c testing. CONCLUSION A high level of COVID-19 transmission was associated with a decrease in undergoing fundus examination and kidney disease screening. To fully realize the potential benefit of diabetes complication screenings, further effort is required to identify and address challenges to obtaining these screenings, especially in outbreak regions.
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Affiliation(s)
- Jieun Jang
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Doo Woong Lee
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Junghwan Suh
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA.
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Gomes Rodrigues DL, Belber GS, Valle de Queiroz Padilha F, Bassolli de Oliveira Alves L, Avezum Á, Maeyama MA, Vitti A, Pompermaier GB, Damas TB, Selbach Otero MS, Souza de Aguiar R, Almeida de Andrade R, Spinel LF, Neves Marques Pinho AP, de Oliveira Junior HA. Teleconsultation on patients with type 2 diabetes in the Brazilian public health system: a randomised, pragmatic, open-label, phase 2, non-inferiority trial (TELECONSULTA diabetes trial). LANCET REGIONAL HEALTH. AMERICAS 2024; 39:100923. [PMID: 39507367 PMCID: PMC11539159 DOI: 10.1016/j.lana.2024.100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 10/05/2024] [Accepted: 10/09/2024] [Indexed: 11/08/2024]
Abstract
Background This study addresses the rising burden of type 2 diabetes mellitus, and explores the potential of teleconsultation, as an alternative for diabetes management. The primary objective was to test the hypothesis that teleconsultation is non-inferior to face-to-face consultation in terms of glycaemic control measured as glycated haemoglobin (HbA1c) (non-inferiority margin for the upper confidence interval for the difference between groups of 0,5% in HbA1c) for type 2 diabetes mellitus patients referred from Primary Healthcare to Specialized Care within the SUS. Methods TELECONSULTA, is a randomized, pragmatic, phase 2, single-centre, open-label, non-inferiority trial conducted in Joinville, Brazil. A total of 278 participants diagnosed with type 2 diabetes were randomized through mandatory teleconsulting services from primary care health units. The randomization was 1:1 to teleconsultation or face to face consultation. The study was registered at the Brazilian Clinical Trial Register-REBEC, under the code RBR-8gpgyd. Study status is "Completed". Findings This study included 278 participants in the intention-to-treat (ITT) analysis. The median age was 61 (54-68) years, 167 (60%) were women. The between-groups comparative average reduction in HbA1c was -0.6% (90% CI -1.0; -0.1) at 3-months and -0.5% (90% CI -0.9; 0.0) at 6-months in Modified Intention-to-Treat (mITT) population with imputed data, showing the non-inferiority of teleconsultation. Results with no missing data imputation and in the per protocol population were similar. The frequency of hypoglycaemia and other adverse events was well balanced between groups. Interpretation The results underscore the transformative potential of telemedicine in addressing the complexities of diabetes management within the framework of a universal healthcare system, contributing with valuable insights for healthcare policymakers and practitioners seeking innovative solutions to tackle the growing diabetes epidemic. Funding This study was funded by the Brazilian Ministry of Health, through the Unified Health System-Institutional Development Support Program (PROADI-SUS).
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Affiliation(s)
| | | | | | | | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | - Alexsandra Vitti
- Municipal Secretary of Health of Joinville, Santa Catarina, Brazil
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Flynn S, Kirwan E, MacGilchrist C, McIntosh C. The impact of COVID-19 on the care of diabetic foot ulcers: A scoping review. J Tissue Viability 2024; 33:521-529. [PMID: 38981778 DOI: 10.1016/j.jtv.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 06/11/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
AIM The aims and objectives of this scoping review were to conduct a systematic search of the literature to identify the nature and extent of the research evidence to which the COVID-19 pandemic impacted and disrupted the care of Diabetic Foot Ulcers (DFU) and the subsequent impact on patient outcomes. Secondly, to identify transformation in models of care and service delivery, adoption of innovative technologies and new models of service innovations, including modalities such as telehealth that were adopted during the pandemic. METHODS This systematic scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR). RESULTS Nineteen papers were included. These studies explored aspects of care for DFUs during the COVID-19 pandemic. The focus of these studies ranged from exploring new modalities of care such as telehealth, reporting of clinical outcomes, development of triage systems and patient behaviors during COVID-19. CONCLUSION Ten of twelve studies reported on DFU outcomes and reported a worsening of outcomes compared to pre-pandemic times. Reduced DFU presentations, alongside an increase in urgent hospitalisations and amputation, were key themes that emerged from this review. More high-quality evidence is needed to establish any longer-lasting effects of the Covid-19 pandemic on people living with DFU. Further, there is a lack of evidence relating to the feasibility and success of telemedicine and limited data on changes to service delivery, including triage systems in this patient cohort.
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Affiliation(s)
- Sinead Flynn
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds (ARIW), College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland.
| | - Ellen Kirwan
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland
| | - Claire MacGilchrist
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds (ARIW), College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Caroline McIntosh
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds (ARIW), College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
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Xiaoling W, Shengmei Z, BingQian W, Wen L, Shuyan G, Hanbei C, Chenjie Q, Yao D, Jutang L. Enhancing diabetic foot ulcer prediction with machine learning: A focus on Localized examinations. Heliyon 2024; 10:e37635. [PMID: 39386877 PMCID: PMC11462210 DOI: 10.1016/j.heliyon.2024.e37635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 09/03/2024] [Accepted: 09/06/2024] [Indexed: 10/12/2024] Open
Abstract
Background diabetices foot ulcer (DFU) are serious complications. It is crucial to detect and diagnose DFU early in order to provide timely treatment, improve patient quality of life, and avoid the social and economic consequences. Machine learning techniques can help identify risk factors associated with DFU development. Objective The aim of this study was to establish correlations between clinical and biochemical risk factors of DFU through local foot examinations based on the construction of predictive models using automated machine learning techniques. Methods The input dataset consisted of 566 diabetes cases and 50 DFU risk factors, including 9 local foot examinations. 340 patients with Class 0 labeling (low-risk DFU), 226 patients with Class 1 labeling (high-risk DFU). To divide the training group (consisting of 453 cases) and the validation group (consisting of 113 cases), as well as preprocess the data and develop a prediction model, a Monte Carlo cross-validation approach was employed. Furthermore, potential high-risk factors were analyzed using various algorithms, including Bayesian BYS, Multi-Gaussian Weighted Classifier (MGWC), Support Vector Machine (SVM), and Random Forest Classifier (RF). A three-layer machine learning training was constructed, and model performance was estimated using a Confusion Matrix. The top 30 ranking feature variables were ultimately determined. To reinforce the robustness and generalizability of the predictive model, an independent dataset comprising 248 cases was employed for external validation. This validation process evaluated the model's applicability and reliability across diverse populations and clinical settings. Importantly, the external dataset required no additional tuning or adjustment of parameters, enabling an unbiased assessment of the model's generalizability and its capacity to predict the risk of DFU. Results The ensemble learning method outperformed individual classifiers in various performance evaluation metrics. Based on the ROC analysis, the AUC of the AutoML model for assessing diabetic foot risk was 88.48 % (74.44-97.83 %). Other results were found to be as follows: 87.23 % (63.33 %-100.00 %) for sensitivity, 87.43 % (70.00 %-100.00 %) for specificity, 87.33 % (76.66 %-95.00 %) for accuracy, 87.69 % (75.00 %-100.00 %) for positive predictive value, and 87.70 % (71.79 %-100.00 %) for negative predictive value. In addition to traditional DFU risk factors such as cardiovascular disorders, peripheral artery disease, and neurological damage, we identified new risk factors such as lower limb varicose veins, history of cerebral infarction, blood urea nitrogen, GFR (Glomerular Filtration Rate), and type of diabetes that may be related to the development of DFU. In the external validation set of 158 samples, originating from an initial 248 with exclusions due to missing labels or features, the model still exhibited strong predictive accuracy. The AUC score of 0.762 indicated a strong discriminatory capability of the model. Furthermore, the Sensitivity and Specificity values provided insights into the model's ability to correctly identify both DFU cases and non-cases, respectively. Conclusion The predictive model, developed through AutoML and grounded in local foot examinations, has proven to be a robust and practical instrument for the screening, prediction, and diagnosis of DFU risk. This model not only aids medical practitioners in the identification of potential DFU cases but also plays a pivotal role in mitigating the progression towards adverse outcomes. And the recent successful external validation of our DFU risk prediction model marks a crucial advancement, indicating its readiness for clinical application. This validation reinforces the model's efficacy as an accessible and reliable tool for early DFU risk assessment, thereby facilitating prompt intervention strategies and enhancing overall patient outcomes.
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Affiliation(s)
- Wang Xiaoling
- Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Zhu Shengmei
- Department of Pediatric Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Wang BingQian
- Intensive Care Medicine Department, Suzhou Traditional Chinese Medicine Hospital, Suzhou, Jiangsu 215009, China
| | - Li Wen
- Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Gu Shuyan
- Center for Health Policy and Management Studies, School of Government, Nanjing University, Nanjing 210023, China
| | - Chen Hanbei
- Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Qin Chenjie
- Department of Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Dai Yao
- Nursing Department of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Li Jutang
- Hongqiao International Institute of Medicine,Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai 200336, China
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Blytt KM, Kolltveit BCH, Graue M, Robberstad M, Ternowitz T, Carlsen S, Iversen MM. The implementation of telemedicine in wound care: a qualitative study of nurses' and patients' experiences. BMC Health Serv Res 2024; 24:1146. [PMID: 39343892 PMCID: PMC11439246 DOI: 10.1186/s12913-024-11620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/20/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND The increasing use of telemedicine (TM) represents a major shift for health workers and patients alike. Thus, there is a need for more knowledge on how these interventions work and are implemented. We conducted a qualitative process-evaluation alongside a larger randomized controlled trial designed to evaluate a telemedicine follow-up intervention for patients with a leg- or foot-ulcer, who either have or do not have diabetes. Accordingly, the aim of this study was to explore how both health care professionals and patients experienced the implementation of TM follow-up in primary care. METHODS The intervention comprised an interactive TM platform facilitating guidance and counselling regarding wound care between nurses in primary care and nurses in specialist health care in Norway. Nurses and patients from seven clusters in the intervention arm were included in the study. We conducted 26 individual interviews (14 patients and 12 nurses) in primary care between December 2021 and March 2022. Thematic analyses were conducted. RESULTS The analyses revealed the following themes: (1) enhancing professional self-efficacy for wound care, (2) a need to redesign the approach to implementing TM technology and (3) challenging to facilitate behavioral changes in relation to preventive care. As to patients' experiences with taking part in the intervention, we found the following three themes: (1) experience with TM promotes a feeling of security over time, (2) patients' preferences and individual needs on user participation in TM are not met, and (3) experiencing limited focus on prevention of re-ulceration. CONCLUSIONS TM presents both opportunities and challenges. Future implementation should focus on providing nurses with improved technological equipment and work on how to facilitate the use of TM in regular practice in order to fully capitalize on this new technology. Future TM interventions need to tailor the level of information and integrate a more systematic approach for working with preventive strategies. CLINICAL TRIAL REGISTRATION NCT01710774. Registration Date 2012-10-17.
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Affiliation(s)
- Kjersti Marie Blytt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway.
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway
| | - Mari Robberstad
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Ternowitz
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - Siri Carlsen
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Marjolein Memelink Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
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Drovandi A, Seng L, Golledge J. Effectiveness of educational interventions for diabetes-related foot disease: A systematic review and meta-analysis. Diabetes Metab Res Rev 2024; 40:e3746. [PMID: 37926437 DOI: 10.1002/dmrr.3746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
This systematic review and meta-analysis pooled evidence from randomised controlled trials (RCTs) on the effectiveness of educational programs for people with or at risk of diabetes-related foot disease (DFD). A systematic search identified RCTs evaluating the effectiveness of educational programs in preventing or managing DFD. The primary outcome was risk of developing a foot ulcer. Secondary outcomes included any amputation, mortality, changes in cardiovascular risk factors, foot-care knowledge and self-care behaviours. Meta-analyses were performed using random effects models. Risk of bias was assessed using Cochrane's ROB-2 tool. Education programs were tested in 29 RCTs (n = 3891) and reduced risk of a foot ulcer by approximately half although the upper 95% confidence interval (CI) reached 1.00 (odds ratio [OR], OR 0.54; 95% CI 0.29, 1.00, I2 = 65%). Education programs reduced risk of any amputation (OR 0.34; 95% CI 0.13, 0.88, I2 = 38%) and HbA1c levels (standardized mean difference -0.73; 95% CI -1.26, -0.20, I2 = 93%) without affecting all-cause mortality (OR 1.09; 95% CI 0.57, 2.07, I2 = 0%). Education programs mostly significantly improved DFD knowledge (13 of 16 trials) and self-care behaviour scores (19 of 20 trials). Only one trial was deemed at low risk of bias. Previously tested education programs have mostly effectively improved participants' knowledge and self-care behaviours and reduced risk of foot ulceration and amputation. Larger high quality trials with longer follow-up are needed.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Gurcay B, Yilmaz FT, Bilgin A. The Effectiveness of Telehealth Interventions on Medication Adherence Among Patients with Type 2 Diabetes: A Meta-Analysis. Telemed J E Health 2024; 30:3-20. [PMID: 37219578 DOI: 10.1089/tmj.2023.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Objective: Diabetes mellitus (DM) is a global health issue with an increasing frequency across the world and is an important disease in which medication adherence is a priority component for disease management. Several interventions are implemented to increase medication adherence in patients with type 2 DM, and telehealth interventions have become widespread thanks to technological advancements. This meta-analysis aims at reviewing the telehealth interventions applied to patients with type 2 DM and examining their effects on medication adherence. Methods: Relevant studies published in ScienceDirect, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed from 2000 to December 2022 were searched in this meta-analysis. Their methodological quality was assessed using the Modified Jadad scale. Total score for each study ranged from 0 (low quality) to 8 (high quality). Studies with four or more were of good quality. Standardized mean difference (SMD) and 95% confidence intervals (CI) were used for statistical analysis. Publication bias was assessed using the funnel plot and Egger regression test. Both subgroup analysis and meta-regression analysis were performed in the study. Results: A total of 18 studies were analyzed in this meta-analysis. All studies scored 4 or above in their methodological quality assessment and were of good quality. The combined results have shown that telehealth interventions significantly increased medication adherence in the intervention group (SMD = 0.501; 95% CI 0.231-0.771; Z = 3.63, p < 0.001). Our subgroup analysis has revealed that HbA1c value, mean age, and duration of intervention significantly affected the study results. Conclusion: Telehealth interventions are an effective method to increase medication adherence in patients with type 2 DM. It is recommended that telehealth interventions be expanded in clinical practices and included in disease management.
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Affiliation(s)
- Busra Gurcay
- Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Turkey
| | - Feride Taskin Yilmaz
- Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Turkey
| | - Aylin Bilgin
- Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Turkey
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10
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Dardari D, Franc S, Charpentier G, Orlando L, Bobony E, Bouly M, Xhaard I, Amrous Z, Sall KL, Detournay B, Penfornis A. Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100686. [PMID: 37520145 PMCID: PMC10384180 DOI: 10.1016/j.lanepe.2023.100686] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Background Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial). Methods Eligible patients (n = 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed. Findings In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0-17.8]) than in the intervention group (7.1 days [2.8-11.5]) (p = 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144-9226) in the control group and 3471 € (95% CI 1430-5512) in the intervention group (p = 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population. Interpretation The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings. Funding This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d'Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.
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Affiliation(s)
- Dured Dardari
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- LBEPS, Université d’Evry, IRBA, Université de Paris-Saclay, Evry, France
| | - Sylvia Franc
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Guillaume Charpentier
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Laurent Orlando
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Elise Bobony
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Marie Bouly
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
| | - Ilham Xhaard
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Zohra Amrous
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Khadijatou Ly Sall
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Bruno Detournay
- CEMKA, 43, Boulevard du Maréchal Joffre, Bourg-La-Reine 92340, France
| | - Alfred Penfornis
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Saint-Aubin, France
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11
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Søndergaard SF, Vestergaard EG, Andersen AB, Kolbæk R, Dahl M, Høgh A. How patients with diabetic foot ulcers experience telemedicine solutions: A scoping review. Int Wound J 2023; 20:1796-1810. [PMID: 36453130 PMCID: PMC10088844 DOI: 10.1111/iwj.14026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Diabetic foot ulcer (DFU) is a common, complex and severe complication of diabetes that is associated with severely decreased health-related quality of life. Treatment of DFUs calls for a multi-sectoral approach, incorporating interdisciplinary care pathways. Telemedicine (TM) may be used as a communication tool between caregivers across healthcare sectors to obligate the need for close follow-up, including early intervention in preventing the recurrence of DFU. The objective of this review was to identify, examine and conceptually map the available literature on patients' experiences and views regarding the use of TM solutions among patients with DFUs. We identified the Population, Concept and Context to pinpoint the focus of this review, word the research question and title as well as facilitate the literature search strategy. The literature examined stems from 13 sources. We imposed no restrictions on the methodological approach of the included studies, neither on the format. During the review process, four main maps emerged: "A whole human not merely a hole in a human," "Less of a burden on the family, the community and the environment," "Competences and continuity of care are essential for high-quality care" and "The quality and modality of the technology." Further investigation from both the patients' and the multi-sectoral caregivers' perspective is needed, focusing on whatever modifications of the TM intervention may fit the DFU care pathway better.
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Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical NursingRegional Hospital ViborgViborgDenmark
- VIA University College and Aarhus University, HealthAarhusDenmark
| | - Else Godsk Vestergaard
- Wound Nurse, Vascular Research Unit, Department of SurgeryViborg Regional HospitalViborgDenmark
| | - Anne Bendix Andersen
- Centre for Research in Clinical NursingRegional Hospital ViborgViborgDenmark
- VIA University College and Aarhus University, HealthAarhusDenmark
| | | | - Marie Dahl
- Vascular Research Unit, Department of SurgeryViborg Regional HospitalViborgDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Clinical ResearchUniversity of Southern Denmark and Odense University HospitalOdenseDenmark
| | - Annette Høgh
- Vascular Research Unit and Wound Centre. Department of SurgeryRegional Hospital Viborg, Region Central JutlandViborgDenmark
- Institute for Clinical MedicineAarhus UniversityAarhusDenmark
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12
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Parise AC, Coria HE, López V, Santini Araujo MG. Pie diabético y pandemia de la COVID-19: adaptación al uso de la Telemedicina por los especialistas de pie y tobillo de los Servicios de Traumatología de la Argentina. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2023. [DOI: 10.15417/issn.1852-7434.2023.88.1.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Introducción: La telemedicina fue la recomendación internacional durante la pandemia de COVID-19 para las consultas médicas de los pacientes con pie diabético. El objetivo de este estudio fue analizar el empleo de la telemedicina como herramienta en pacientes con pie diabético, por parte de especialistas en pie y tobillo de la Argentina. Como objetivos secundarios se planteó valorar la satisfacción percibida por los profesionales con el uso de esta herramienta, evaluar qué estrategias se usaron para realizar la consulta médica remota y determinar la permanencia al retornar a la actividad asistencial habitual.
Materiales y Métodos: Se enviaron tres encuestas a los socios de la Sociedad Argentina de Medicina y Cirugía de la Pierna y Pie, entre mayo 2020 y abril de 2022.
Resultados: La función más valiosa de la consulta remota fue la prevención (75% de los encuestados), el seguimiento clínico (54,1%), el seguimiento posoperatorio (41,6%) y el diagnóstico (29,1%). El recurso más utilizado fue la conversación telefónica, seguida del envío de imágenes por mensajería instantánea. Solo el 37,5% utilizó las plataformas de historia clínica virtual.
Conclusiones: Los recursos más utilizados para la consulta remota fueron la conversación telefónica, seguida del envío de imágenes por mensajería instantánea. El 33,4% estaba conforme con la consulta por telemedicina en mayo de 2020, mientras que, en julio, la conformidad ascendió al 46,7%. En abril de 2022, solo el 13% continuaba con las consultas remotas.
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13
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Aan de Stegge WB, Van Netten JJ, Bus SA. Does the skin heat up before it breaks down in diabetic foot ulceration? Diabetes Metab Res Rev 2023:e3621. [PMID: 36752702 DOI: 10.1002/dmrr.3621] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/17/2022] [Accepted: 01/02/2023] [Indexed: 02/09/2023]
Abstract
AIMS Most diabetic foot ulcers are caused by tissue stress from being ambulatory in people without protective sensation. These ulcers are suggested to be preceded by local skin temperature increase due to inflammation of the underlying tissue, a so-called hotspot. Evidence to support this mechanism of ulcer development is meagre at best. We investigated if foot ulcers are preceded by increased skin temperature in people with diabetes and foot ulcer history. MATERIAL AND METHODS Participants measured temperature at 6-8 plantar foot locations each day for 18 months and identified a hotspot with a temperature difference >2.2°C between corresponding foot locations for two consecutive days. RESULTS Twenty-nine of 151 participants developed a non-traumatic ulcer while adhering to temperature measurements. In the 2 months prior to ulceration, 8 (28%) had a true hotspot (i.e. at/adjacent to the ulcer location) and the hotspot was on average no longer present 9 days before ulceration. Seven (24%) participants had a false hotspot (i.e. at another location) and 14 (48%) had no hotspot. CONCLUSIONS The skin of the majority of the ulcers does not heat up before it breaks down or, when it does, not directly before breakdown, questioning the foot temperature increase-uslcer association.
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Affiliation(s)
- Wouter B Aan de Stegge
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Vascular Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - Jaap J Van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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14
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Lo ZJ, Chong B, Tan E, Ooi D, Liew H, Hoi WH, Cho YT, Wu K, Surendra NK, Mammadova M, Nah A, Goh V, Car J. Patients, carers and healthcare providers' perspectives on a patient-owned surveillance system for diabetic foot ulcer care: A qualitative study. Digit Health 2023; 9:20552076231183544. [PMID: 37377563 PMCID: PMC10291864 DOI: 10.1177/20552076231183544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Objective Digital health has recently gained a foothold in monitoring and improving diabetes care. We aim to explore the views of patients, carers and healthcare providers (HCPs) regarding the use of a novel patient-owned wound surveillance application as part of outpatient management of patients with diabetic foot ulcers (DFUs). Methods Semi-structured online interviews were conducted with patients, carers and HCPs in wound care for DFUs. The participants were recruited from a primary care polyclinic network and two tertiary hospitals in Singapore, within the same healthcare cluster. Purposive maximum variation sampling was used to select participants with differing attributes to ensure heterogeneity. Common themes relating to the wound imaging app were captured. Results A total of 20 patients, 5 carers and 20 HCPs participated in the qualitative study. None of the participants have used a wound imaging app before. Regarding a patient-owned wound surveillance app, all were open and receptive to the system and workflow for use in DFU care. Four major themes emerged from patients and carers: (1) technology, (2) application features and usability, (3) feasibility of using the wound imaging application and (4) logistics of care. Four major themes were identified from HCPs: (1) attitudes towards wound imaging app, (2) preferences regarding functionality, (3) perceived challenges for patients/carers and (4) perceived barriers for HCPs. Conclusion Our study highlighted several barriers and facilitators from patients, carers and HCPs regarding the use of a patient-owned wound surveillance app. These findings demonstrate the potential of digital health and areas to improve and tailor a DFU wound app suitable for implementation in the local population.
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Affiliation(s)
- Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elaine Tan
- National Healthcare Group Polyclinics, Singapore
| | - Desmond Ooi
- Vascular Surgery Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Wai Han Hoi
- Department of Endocrinology, Woodlands Health, Singapore
| | - Yuan Teng Cho
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore
| | | | - Naren Kumar Surendra
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Maleyka Mammadova
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Audrey Nah
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Victor Goh
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
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15
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Stojmanovski Mercieca LA, Formosa C, Chockalingam N. A scoping review of foot and ankle telemedicine guidelines. Health Sci Rep 2023; 6:e1076. [PMID: 36698701 PMCID: PMC9860371 DOI: 10.1002/hsr2.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
Background and Aims The COVID-19 pandemic accelerated the adoption of telemedicine in general. Its use has been widely adopted in the healthcare sector, but relatively little research has been conducted on the use of telemedicine for podiatry. This review aimed to explore and compare existing guidelines on telemedicine related to foot and ankle pathologies within a primary care setting. Methods The preferred reporting guidelines for the extension of scoping reviews were used in this review, and a set of inclusion and exclusion criteria were developed and implemented. This study made use of both databases and gray literature searches. Between 2012 and 2022, these databases were searched using various subject headings and free-text terms for the keywords "telemedicine" "foot health" and "guidelines" with appropriate Boolean operators. Results The search yielded 356 articles, which were reduced to 283 after removing duplicates. Six more records were discovered through a Google and Google Scholar search and one through an article reference search. Six articles and three institutional practice guidelines were selected for synthesis after screening. The findings were classified according to the level of evidence and research quality, the function of telemedicine and the communication used, the research outcomes sought, and the type of recommendations and guidelines made available. Conclusion This review highlights the lack of podiatric telemedicine guidelines for foot and ankle pathologies. Although foot and ankle guidelines for orthopedic and musculoskeletal virtual consultations have been mentioned, they do not cover the full range of potential case scenarios that fall within the remit of podiatric consultations in a primary care setting. This review suggests the development of foot and ankle telemedicine guidelines with recommendations on how they can better provide accessible care to their patients, making foot and ankle care management not only a hand-on-one but also reachable virtually, where applicable.
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Affiliation(s)
| | - Cynthia Formosa
- Faculty of Health SciencesUniversity of MaltaMsidaMalta
- Centre for Biomechanics and Rehabilitation TechnologiesStaffordshire UniversityStoke‐on‐TrentUK
| | - Nachiappan Chockalingam
- Faculty of Health SciencesUniversity of MaltaMsidaMalta
- Centre for Biomechanics and Rehabilitation TechnologiesStaffordshire UniversityStoke‐on‐TrentUK
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16
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Drovandi A, Wong S, Seng L, Crowley B, Alahakoon C, Banwait J, Fernando ME, Golledge J. Remotely Delivered Monitoring and Management of Diabetes-Related Foot Disease: An Overview of Systematic Reviews. J Diabetes Sci Technol 2023; 17:59-69. [PMID: 34008448 PMCID: PMC9846412 DOI: 10.1177/19322968211012456] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetes-related foot disease (DFD) management requires input from multiple healthcare professionals, and has worse outcomes for people living in remote localities by comparison to urban areas. Remotely delivered healthcare may reduce this disparity. This overview summarizes current evidence on the effectiveness, stakeholder perceptions, and cost-effectiveness of remotely delivered healthcare for DFD. METHODS A search of 5 databases was conducted to identify systematic reviews published between January 2000 and June 2020. Eligible reviews were those evaluating remotely delivered monitoring or management of patients at risk of or with active DFD, or clinicians managing these patients. Risk of bias was assessed using the AMSTAR-2 tool. RESULTS Eight reviews were eligible for inclusion, including 88 primary studies and 8509 participants, of which 36 studies involving 4357 participants evaluated remotely delivered monitoring or management of DFD. Only one review had a low risk of bias, with most reviews demonstrating limited search strategies and poor reporting of participants. Evidence on effectiveness was mixed, with meta-analyses demonstrating long-term ulcer healing and mortality were not significantly different between telehealth and standard care groups, although the lower-limb amputation rate was significantly decreased in one meta-analysis. Perceptions of telehealth by patients and clinicians were generally positive, whilst acknowledging limitations relating to access and use. Cost-effectiveness data were limited, with poor reporting preventing clear conclusions. CONCLUSIONS Remotely delivered healthcare of DFD is well received by patients and clinicians, but its effectiveness is unclear. High quality trials are needed to evaluate the risks and benefits of remotely delivered DFD management.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
| | - Shannon Wong
- College of Medicine and Dentistry,
James Cook University, Townsville, Queensland, Australia
| | - Leonard Seng
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
| | - Benjamin Crowley
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
| | - Chanika Alahakoon
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
| | - Jasmin Banwait
- College of Medicine and Dentistry,
James Cook University, Townsville, Queensland, Australia
| | - Malindu E. Fernando
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
- Ulcer and wound Healing consortium
(UHEAL), Australian Institute of Tropical Health and Medicine, James Cook
University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Queensland, Australia
- Ulcer and wound Healing consortium
(UHEAL), Australian Institute of Tropical Health and Medicine, James Cook
University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular
Surgery, Townsville University Hospital, Townsville, Queensland, Australia
- Jonathan Golledge, MChir, Queensland
Research Centre for Peripheral Vascular Disease, College of Medicine and
Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland
4811, Australia.
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Applewhite AI, Pujalte GGA, Denay K, Odom MJ, Arizpe A, Albano-Aluquin S, Kinaszczuk AM, Aiyer A. Foot evaluation via telephone and video virtual medical visits. Musculoskeletal Care 2022; 20:772-783. [PMID: 35524702 DOI: 10.1002/msc.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Telemedicine plays a very important role in our society by allowing providers to treat patients who do not have easy access to a healthcare facility, especially in the setting of the COVID-19 pandemic. OBJECTIVE We aimed to create an extensive, yet concise guide for medical providers to virtually evaluate patients with foot concerns. METHODS This article outlines how to conduct a well-planned virtual consultation with specific questions, instructions, and examination manoeuvres to navigate musculoskeletal foot problems. CONCLUSION With this narrative review, we have provided a guide with suggestions, questions and interpretations of answers to help physicians new to the practice of telemedicine have successful virtual encounters with patients suffering from foot musculoskeletal ailments.
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Affiliation(s)
| | - George G A Pujalte
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Orthopedics and Sports Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Keri Denay
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mitchell J Odom
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Azael Arizpe
- Department of Orthopaedics, University of Miami, Miami, Florida, USA
| | - Shirley Albano-Aluquin
- Department of Rheumatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Anja M Kinaszczuk
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Amiethab Aiyer
- Department of Orthopaedics, University of Miami, Miami, Florida, USA
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18
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Crawford F, Nicolson DJ, Amanna AE, Smith M. Reliability of the evidence to guide decision-making in foot ulcer prevention in diabetes: an overview of systematic reviews. BMC Med Res Methodol 2022; 22:274. [PMID: 36266628 PMCID: PMC9583498 DOI: 10.1186/s12874-022-01738-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Reliable evidence on the effectiveness of interventions to prevent diabetes-related foot ulceration is essential to inform clinical practice. Well-conducted systematic reviews that synthesise evidence from all relevant trials offer the most robust evidence for decision-making. We conducted an overview to assess the comprehensiveness and utility of the available secondary evidence as a reliable source of robust estimates of effect with the aim of informing a cost-effective care pathway using an economic model. Here we report the details of the overview. [PROSPERO Database (CRD42016052324)]. Methods Medline (Ovid), Embase (Ovid), Epistomonikos, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE), and the Health Technology Assessment Journals Library were searched to 17th May 2021, without restrictions, for systematic reviews of randomised controlled trials (RCTs) of preventive interventions in people with diabetes. The primary outcomes of interest were new primary or recurrent foot ulcers. Two reviewers independently extracted data and assessed the risk of bias in the included reviews. Findings The overview identified 30 systematic reviews of patient education, footwear and off-loading, complex and other interventions. Many are poorly reported and have fundamental methodological shortcomings associated with increased risk of bias. Most concerns relate to vague inclusion criteria (60%), weak search or selection strategies (70%) and quality appraisal methods (53%) and inexpert conduct and interpretation of quantitative and narrative evidence syntheses (57%). The 30 reviews have collectively assessed 26 largely poor-quality RCTs with substantial overlap. Interpretation The majority of these systematic reviews of the effectiveness of interventions to prevent diabetic foot ulceration are at high risk of bias and fail to provide reliable evidence for decision-making. Adherence to the core principles of conducting and reporting systematic reviews is needed to improve the reliability of the evidence generated to inform clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01738-y.
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Affiliation(s)
- Fay Crawford
- The School of Medicine, The University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK.
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19
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Tsagkaris C, Shkodina A, Matiashova L. The war in Ukraine and diabetic foot care: Challenges, recommendations. Diabetes Metab Syndr 2022; 16:102618. [PMID: 36152445 DOI: 10.1016/j.dsx.2022.102618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/07/2022] [Accepted: 09/10/2022] [Indexed: 11/22/2022]
Abstract
AIMS A number of reports have illustrated the barriers that the war in Ukraine puts to diabetes care. While their recommendations are valuable for glycemic control and the prevention or early detection of life - threatening diabetes complications, such as hypoglycemia and ketoacidosis, the discourse on diabetic foot is limited. This letter emphasizes the implications of the war in diabetic foot care and discusses potential solutions. METHODS The authors searched peer - reviewed and grey literature to identify records related to the prevalence of diabetic foot in Ukraine and the standards of care before and after the invasion of Ukraine. RESULTS Thousands of people in Ukraine sustain diabetic foot ulcers and, thus, are at high risk for lower limb amputations due to the limited access to healthcare services in the country. If not addressed, disability associated with chronic ulcers and amputations can severely affect individual and public health in Ukraine. Strengthening primary and remote care, educating people on self - care and providing adequate supplies for the management of diabetic foot have a major potential to prevent amputations, disability and death. CONCLUSIONS Providing adequate diabetic foot care in Ukraine and other regions tormented by armed conflicts is vital for the health of the local population and the potential of the affected countries to recover after the crisis.
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Affiliation(s)
- Christos Tsagkaris
- Public Health and Policy Working Group, European Student Think Tank, Amsterdam, Netherlands.
| | - Anastasiia Shkodina
- Poltava State Medical University, Poltava, Ukraine; Neurological Department, Municipal Enterprise "1 City Clinical Hospital of Poltava City Council", Poltava, Ukraine
| | - Lolita Matiashova
- Public Health and Policy Working Group, European Student Think Tank, Amsterdam, Netherlands; L.T. Mala NIT NAMSU, Kharkiv, Ukraine
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20
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Qin Q, Nakagami G, Ohashi Y, Dai M, Sanada H, Oe M. Development of a self-monitoring tool for diabetic foot prevention using smartphone-based thermography: Plantar thermal pattern changes and usability in the home environment. Drug Discov Ther 2022; 16:169-176. [PMID: 36002308 DOI: 10.5582/ddt.2022.01050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Thermography is a well-known risk-assessment tool for diabetic foot ulcers but is not widely used in the home setting due to the influence of the complicated home environment on thermographic images. This study investigated changes in thermographic images in complicated home environments to determine the feasibility of smartphone-based thermography in home settings. Healthy volunteers (age > 20 years) were recruited and required to take plantar thermal images using smartphone-based thermography attached to a selfie stick at different times of the day for 4 days. The thermal images and associated activities and environmental factors were then analyzed using content analysis. Areas with the highest temperature on the plantar thermal images were described and categorized. Device usability was evaluated using 10-point Likert scales, with 10 representing the highest satisfaction. A total of 140 plantar thermal images from 10 participants were analyzed. In 12 classifications, the three commonest patterns based on the highest temperature location were medial arch (42.1%), whole plantar (10.7%), and forefoot and medial arch (7.9%). The medial arch pattern is most frequently seen after awakening (67.5%) compared to other time points. Device usability was rated 7.5 out of 10 on average. This study was the first to investigate the plantar thermal patterns in the home settings, and the medial arch pattern was the most common hot area, which matches previous findings in well-controlled clinical settings. Therefore, smartphone-based thermography may be feasible as a self-assessment tool in the home setting.
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Affiliation(s)
- Qi Qin
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Ohashi
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Misako Dai
- Research Center for Implementation Nursing Science Initiative, Research Promotion Headquarters, Fujita Health University, Aichi, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Oe
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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21
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Rovers FJ, Van Netten JJ, Busch-Westbroek TE, Aan de Stegge WB, Bus SA. Adherence to at-Home Monitoring of Foot Temperatures in People with Diabetes at High Risk of Ulceration. INT J LOW EXTR WOUND 2022:15347346221114565. [PMID: 35840892 DOI: 10.1177/15347346221114565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We aimed to investigate adherence to at-home monitoring of foot temperature and its association with patient-, disease- and behavior-related factors, in people with diabetes at high risk of ulceration. We analyzed 151 participants in the enhanced therapy arm of the DIATEMP trial (all at high diabetes-related foot ulcer risk) who aimed to perform and log foot temperatures daily for 18 months or until ulceration. Adherence was the proportion of measurement days covered (PDC), with being adherent defined as PDC≥70%. If a hotspot was recorded, adherence to subsequently reducing ambulatory activity was assessed. Multivariate logistic regression analysis was performed to investigate associations with adherence. We found ninety-four participants (62.3%) adherent to measuring foot temperatures. This was higher in months 1-3 versus months 4-18: 118 (78.1%) versus 78 (57.4%; P < .001). Of 83 participants with a hotspot, 24 (28.9%) reduced ambulatory activity. Increasing age (P = .021, OR = 1.045) and better self-care (P = .007, OR = 1.513) were positively associated with adherence to measuring foot temperature. In conclusion, in people at high diabetes-related foot ulcer risk, adherence to measuring foot temperature was high in the first months after study commencing, but dropped over time. Adherence to reducing ambulatory activity when a hotspot was found was low over the entire study period.
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Affiliation(s)
- F J Rovers
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - J J Van Netten
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - T E Busch-Westbroek
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - W B Aan de Stegge
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
| | - S A Bus
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, 1234University of Amsterdam, Amsterdam, The Netherlands
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22
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Obilor HN, Achore M, Woo K. Use of Information Communication Technology Tools in Diabetic Foot Ulcer Prevention Programs: A Scoping Review. Can J Diabetes 2022; 46:535-548.e5. [PMID: 35739048 DOI: 10.1016/j.jcjd.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/16/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Information communication technology (ICT) tools are an integral part of day-to-day human activities. However, evidence of how ICT tools are used to engage individuals with diabetes to prevent diabetic foot ulcers (DFUs) is limited. In this review, we summarize the evidence on ICT tools used in DFU prevention programs and associated outcomes. METHODS We conducted a scoping review of the literature based on the Arksey and O'Malley methodologic framework. Four databases (MEDLINE, Embase, PsycINFO and CINAHL) were searched from 1960 to 2020 using keywords. Two reviewers independently screened the articles and performed data extraction and summarization. RESULTS Seventeen of 312 articles screened met the inclusion criteria and were included in the final analysis. Eleven ICT tools were utilized in 4 types of intervention: patient education, multidimensional foot health programs, remote temperature monitoring and pressure-sensitive insole systems. The identified ICT tools were used for presenting educational information, follow-up reinforcement of education, counselling, self-monitoring, remote patient monitoring by health-care professionals, self-care reminders, problem-solving, motivation and communication. In 59% of the studies, the interventions led to a significant reduction in recurrence of DFUs, improvement in self-care behaviour and cognition, and reduction of risk factors. CONCLUSIONS This review provides insight into a range of ICT tools used in DFU prevention programs. The findings suggest that interventions involving 1 or more ICT tools are often effective in improving diabetic foot care-related outcomes. Therefore, DFU prevention programs should include ICT tools among their components.
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Affiliation(s)
- Helen Ngozichukwuka Obilor
- School of Nursing, Queen's University, Kingston, Ontario, Canada; Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Meshack Achore
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Kevin Woo
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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23
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Establishing and maintaining a remote vascular surgery aortic program: A single-center 5-year experience at the Veterans Affairs. J Vasc Surg 2022; 75:1063-1072. [PMID: 34562570 PMCID: PMC8863634 DOI: 10.1016/j.jvs.2021.08.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We sought to detail the process of establishing a surgical aortic telehealth program and report the outcomes of a 5-year experience. METHODS A telehealth program was established between two regional Veterans Affairs hospitals, one of which was without a comprehensive aortic surgical program, until such a program was established at the referring institution. A retrospective review was performed of all patients who underwent aortic surgery from 2014 to 2019. The operative data, demographics, perioperative complications, and follow-up data were reviewed. RESULTS From 2014 to 2019, 109 patients underwent aortic surgery for occlusive and aneurysmal disease. Preoperative evaluation and postoperative follow-up were done remotely via telehealth. The median age of the patients was 68 years, 107 were men (98.2%), 28 (25.7%) underwent open aortic repair, and 81 (74.3%) underwent endovascular repair. Of the 109 patients, 101 (92.7%) had a median follow-up of 24.3 months, 5 (4.6%) were lost to follow-up or were noncompliant, 2 (1.8%) were noncompliant with their follow-up imaging studies but responded to telephone interviews, and 1 (0.9%) moved to another state. At the 30-day follow-up, eight patients (7.3%) required readmission. Four complications were managed locally, and four patients (3.6%) required transfer back to the operative hospital for additional care. CONCLUSIONS Telehealth is a great tool to provide perioperative care and long-term follow-up for patients with aortic pathologies in remote locations. Most postoperative care and complications can be managed remotely, and patient compliance for long-term follow-up is high.
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Yammine K, Estephan M. Telemedicine and diabetic foot ulcer outcomes. A meta-analysis of controlled trials. Foot (Edinb) 2022; 50:101872. [PMID: 35219129 DOI: 10.1016/j.foot.2021.101872] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/05/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
Telemedicine (TM) has been advanced as an effective approach to wound care management. In this era of COVID-19 pandemic, it is paramount to assess the evidence behind the use of TM in treating diabetic foot ulcers (DFU). This meta-analysis aims at evaluating the efficacy of TM versus face-to-face attendance in managing DFU. In total, four controlled studies were included in the meta-analysis comprising 3 randomized trials. The total pooled sample comprised 816 patients (816 ulcers): 337 in TM group and 479 in the control group. The results were as follows: (a) healing rate OR was 1.35, in favor of TM (p = 0.4), (b) time to heal with means of 73 ± 24.1 days and 83.5 ± 28.4 days, for the TM and control group, respectively (p = 0.35), c) the amputation rate OR was 0.48 (p = 0.007) in favor of the TM group, d) the mortality rate OR was 1.66 (p = 0.2), and e) a trend for lesser cost than face-to-face group (p = 0.4). While future research using large-sampled controlled studies is warranted, the present meta-analysis demonstrated that treating DFU via TM could be at least as effective as to face-to-face attendance. In times where clinic visits are reduced or not possible such as during this COVID-19 pandemic and the likely-to-happen future outbreaks, TM could be a valuable alternative.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon.
| | - Michel Estephan
- Department of Emergency Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
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Kang E, Lee H, Hong KJ, Yun J, Lee JY, Hong YC. General public’s perspectives on telemedicine during the COVID-19 pandemic in Korea: an analysis of the nationwide survey. Epidemiol Health 2022; 44:e2022020. [PMID: 35130418 PMCID: PMC9117104 DOI: 10.4178/epih.e2022020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We investigated the awareness, experience, approval, intention to use, and the desired type of telemedicine among Korean general public. METHODS From November to December 2020, we conducted an online self-reported survey on awareness, experience, approval, and intent to use telemedicine services among Korean residents aged 20 years or older. A total of 2,097 participants completed the survey. RESULTS Of the 2,097 participants, 1,558 (74.3%) were aware of, 1,198 (57.1%) approved of, and 1,474 (70.3%) had the intention to use telemedicine. Participants from regions other than the Seoul metropolitan area and Daegu–Gyeongbuk Province (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 1.02 to 1.63), households with a monthly household income of US$6,000 or more (aOR, 1.44; 95% CI, 1.01 to 2.08), participants who had a college/university or associate’s degree (aOR, 1.35. 95% CI, 1.04 to 1.75) or a master’s degree or above (aOR, 1.73; 95% CI, 1.20 to 2.50), and housewives (aOR, 1.30; 95% CI, 1.03 to 1.64) had higher odds of approval. Elderly participants, those with a chronic disease (aOR, 1.26; 95% CI, 1.04 to 1.54), those who had experienced delays of healthcare services (aOR, 1.94; 95% CI, 1.27 to 2.96), and those who had experience with telemedicine (aOR, 4.28; 95% CI, 1.69 to 10.82) were more likely to intend to use telemedicine services. Regarding types of telemedicine, teleconsultation between doctors showed the highest approval rate (73.1%). CONCLUSIONS In the context of the coronavirus disease 2019 pandemic, more than 70% of participants had already used or intended to use telemedicine at some point. Groups with a substantial need for telemedicine were more in favor of telemedicine.
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Affiliation(s)
- EunKyo Kang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Family Medicine, National Cancer Center, Goyang, Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jieun Yun
- Department of Pharmaceutical Engineering, Cheongju University, Cheongju, Korea
| | - Jin Yong Lee
- ublic Healthcare Center, Seoul National University Hospital, Seoul, Korea
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence: Jin Yong Lee Public Healthcare Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea E-mail:
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Co-correspondence: Yun-Chul Hong Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea E-mail:
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Štotl I, Blagus R, Urbančič-Rovan V. Individualised screening of diabetic foot: creation of a prediction model based on penalised regression and assessment of theoretical efficacy. Diabetologia 2022; 65:291-300. [PMID: 34741637 DOI: 10.1007/s00125-021-05604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/23/2021] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS A large proportion of people with diabetes do not receive proper foot screening due to insufficiencies in healthcare systems. Introducing an effective risk prediction model into the screening protocol would potentially reduce the required screening frequency for those considered at low risk for diabetic foot complications. The main aim of the study was to investigate the value of individualised risk assignment for foot complications for optimisation of screening. METHODS From 2015 to 2020, 11,878 routine follow-up foot investigations were performed in the tertiary diabetes clinic. From these, 4282 screening investigations with complete data containing all of 18 designated variables collected at regular clinical and foot screening visits were selected for the study sample. Penalised logistic regression models for the prediction of loss of protective sensation (LOPS) and loss of peripheral pulses (LPP) were developed and evaluated. RESULTS Using leave-one-out cross validation (LOOCV), the penalised regression model showed an AUC of 0.84 (95% CI 0.82, 0.85) for prediction of LOPS and 0.80 (95% CI 0.78, 0.83) for prediction of LPP. Calibration analysis (based on LOOCV) presented consistent recall of probabilities, with a Brier score of 0.08 (intercept 0.01 [95% CI -0.09, 0.12], slope 1.00 [95% CI 0.92, 1.09]) for LOPS and a Brier score of 0.05 (intercept 0.01 [95% CI -0.12, 0.14], slope 1.09 [95% CI 0.95, 1.22]) for LPP. In a hypothetical follow-up period of 2 years, the regular screening interval was increased from 1 year to 2 years for individuals at low risk. In individuals with an International Working Group on the Diabetic Foot (IWGDF) risk 0, we could show a 40.5% reduction in the absolute number of screening examinations (3614 instead of 6074 screenings) when a 10% risk cut-off was used and a 26.5% reduction (4463 instead of 6074 screenings) when the risk cut-off was set to 5%. CONCLUSIONS/INTERPRETATION Enhancement of the protocol for diabetic foot screening by inclusion of a prediction model allows differentiation of individuals with diabetes based on the likelihood of complications. This could potentially reduce the number of screenings needed in those considered at low risk of diabetic foot complications. The proposed model requires further refinement and external validation, but it shows the potential for improving compliance with screening guidelines.
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Affiliation(s)
- Iztok Štotl
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sports, University of Ljubljana, Ljubljana, Slovenia
| | - Vilma Urbančič-Rovan
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Patient and Provider Perspective of Smart Wearable Technology in Diabetic Foot Ulcer Prevention: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121359. [PMID: 34946304 PMCID: PMC8707196 DOI: 10.3390/medicina57121359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/11/2022]
Abstract
Background and Objectives: Smart wearable devices are effective in diabetic foot ulcer (DFU) prevention. However, factors determining their acceptance are poorly understood. This systematic review aims to examine the literature on patient and provider perspectives of smart wearable devices in DFU prevention. Materials and Methods: PubMed, Scopus, and Web of Science were systematically searched up to October 2021. The selected articles were assessed for methodological quality using the quality assessment tool for studies with diverse designs. Results: A total of five articles were identified and described. The methodological quality of the studies ranged from low to moderate. Two studies employed a quantitative study design and focused on the patient perspective, whereas three studies included a mixed, quantitative/qualitative design and explored patient or provider (podiatrist) perspectives. Four studies focused on an insole system and one included a smart sock device. The quantitative studies demonstrated that devices were comfortable, well designed and useful in preventing DFU. One mixed design study reported that patients did not intend to adopt an insole device in its current design because of malfunctions, a lack of comfort. and alert intrusiveness, despite the general perception that the device was a useful tool for foot risk monitoring. Two mixed design studies found that performance expectancy was a predictor of a podiatrist's behavioural intention to recommend an insole device in clinical practice. Disappointing participant experiences negatively impacted the podiatrists' intention to adopt a smart device. The need for additional refinements of the device was indicated by patients and providers before its use in this population. Conclusions: The current evidence about patient and provider perspectives on smart wearable technology is limited by scarce methodological quality and conflicting results. It is, thus, not possible to draw definitive conclusions regarding acceptability of these devices for the prevention of DFU in people with diabetes.
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Artificial Intelligence Evidence-Based Current Status and Potential for Lower Limb Vascular Management. J Pers Med 2021; 11:jpm11121280. [PMID: 34945749 PMCID: PMC8705683 DOI: 10.3390/jpm11121280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/14/2022] Open
Abstract
Consultation prioritization is fundamental in optimal healthcare management and its performance can be helped by artificial intelligence (AI)-dedicated software and by digital medicine in general. The need for remote consultation has been demonstrated not only in the pandemic-induced lock-down but also in rurality conditions for which access to health centers is constantly limited. The term “AI” indicates the use of a computer to simulate human intellectual behavior with minimal human intervention. AI is based on a “machine learning” process or on an artificial neural network. AI provides accurate diagnostic algorithms and personalized treatments in many fields, including oncology, ophthalmology, traumatology, and dermatology. AI can help vascular specialists in diagnostics of peripheral artery disease, cerebrovascular disease, and deep vein thrombosis by analyzing contrast-enhanced magnetic resonance imaging or ultrasound data and in diagnostics of pulmonary embolism on multi-slice computed angiograms. Automatic methods based on AI may be applied to detect the presence and determine the clinical class of chronic venous disease. Nevertheless, data on using AI in this field are still scarce. In this narrative review, the authors discuss available data on AI implementation in arterial and venous disease diagnostics and care.
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Bus SA, Aan de Stegge WB, van Baal JG, Busch-Westbroek TE, Nollet F, van Netten JJ. Effectiveness of at-home skin temperature monitoring in reducing the incidence of foot ulcer recurrence in people with diabetes: a multicenter randomized controlled trial (DIATEMP). BMJ Open Diabetes Res Care 2021; 9:9/1/e002392. [PMID: 34493496 PMCID: PMC8424833 DOI: 10.1136/bmjdrc-2021-002392] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The skin of people with diabetic foot disease is thought to heat up from ambulatory activity before it breaks down into ulceration. This allows for early recognition of imminent ulcers. We assessed whether at-home monitoring of plantar foot skin temperature can help prevent ulcer recurrence in diabetes. RESEARCH DESIGN AND METHODS In this parallel-group outcome-assessor-blinded multicenter randomized controlled trial (7 hospitals, 4 podiatry practices), we randomly assigned people with diabetes, neuropathy, foot ulcer history (<4 years, n=295), or Charcot's neuro-arthropathy (n=9) to usual care (ie, podiatric treatment, education, and therapeutic footwear) or usual care plus measuring skin temperatures at 6-8 plantar sites per foot each day (enhanced therapy). If ∆T>2.2°C between corresponding sites on the left and right foot for two consecutive days, participants were instructed to reduce ambulatory activity until this hotspot disappeared and contact their podiatrist. Primary outcome was ulcer recurrence in 18 months on the plantar foot, interdigital, or medial/lateral/anterior forefoot surfaces; secondary outcome was ulcer recurrence at any foot site. RESULTS On the basis of intention-to-treat, 44 of 151 (29.1%) participants in enhanced therapy and 57 of 153 (37.3%) in usual care had ulcer recurrence at a primary outcome site (RR: 0.782 (95%CI 0.566 to 1.080), p=0.133). Of the 83 participants in enhanced therapy who measured a hotspot, the 24 subsequently reducing their ambulatory activity had significantly fewer ulcer recurrences (n=3) than those in usual care (RR: 0.336 (95% CI 0.114 to 0.986), p=0.017). Enhanced therapy was effective over usual care for ulcer recurrence at any foot site (RR: 0.760 (95% CI 0.579 to 0.997), p=0.046). CONCLUSIONS At-home foot temperature monitoring does not significantly reduce incidence of diabetic foot ulcer recurrence at or adjacent to measurement sites over usual care, unless participants reduce ambulatory activity when hotspots are found, or when aiming to prevent ulcers at any foot site. TRIAL REGISTRATION NUMBER NTR5403.
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Affiliation(s)
- Sicco A Bus
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Wouter B Aan de Stegge
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, The Netherlands
| | - Jeff G van Baal
- Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, The Netherlands
| | - Tessa E Busch-Westbroek
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Frans Nollet
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jaap J van Netten
- Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Progression to unscheduled hospital admissions in people with diabetes: a qualitative interview study. BJGP Open 2021; 5:BJGPO.2021.0044. [PMID: 33910915 PMCID: PMC8450884 DOI: 10.3399/bjgpo.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND People with diabetes often have difficulty maintaining optimal blood glucose levels, risking progressive complications that can lead to unscheduled care. Unscheduled care can include attending emergency departments, ambulance callouts, out-of-hours care, and non-elective hospital admissions. A large proportion of non-elective hospital admissions involve people with diabetes, with significant health and economic burden. AIM To identify precipitating factors influencing diabetes-related unscheduled hospital admissions, exploring potential preventive strategies to reduce admissions. DESIGN & SETTING Thirty-six people with type 1 (n = 11) or type 2 (n = 25) diabetes were interviewed. They were admitted to hospital for unscheduled diabetes-related care across three hospitals in Scotland, Northern Ireland, and the Republic of Ireland. Participants were admitted for peripheral limb complications (n = 17), hypoglycaemia (n = 5), hyperglycaemia (n = 6), or for comorbidities presenting with erratic blood glucose levels (n = 8). METHOD Factors precipitating admissions were examined using framework analysis. RESULTS Three aspects of care influenced unscheduled admissions: perceived inadequate knowledge of diabetes complications; restricted provision of care; and complexities in engagement with self-care and help-seeking. Limited specialist professional knowledge of diabetes by staff in primary and community care, alongside inadequate patient self-management knowledge, led to inappropriate treatment and significant delays. This was compounded by restricted provision of care, characterised by poor access to services - in time and proximity - and poor continuity of care. Complexities in patient engagement, help-seeking, and illness beliefs further complicated the progression to unscheduled admissions. CONCLUSION Dedicated investment in primary care is needed to enhance provision of and access to services. There should be increased promotion and earlier diabetes specialist team involvement, alongside training and use of technology and telemedicine, to enhance existing care.
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Aberer F, Hochfellner DA, Mader JK. Application of Telemedicine in Diabetes Care: The Time is Now. Diabetes Ther 2021; 12:629-639. [PMID: 33474646 PMCID: PMC7816834 DOI: 10.1007/s13300-020-00996-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
The utilization of telemedicine solutions to reduce outpatient clinic visits and visits to physicians' offices, thus saving financial and personal resources as well as time, has gained substantial importance in recent years. The COVID19 pandemic has made it necessary to abruptly adjust outpatient care methods in various medical settings that needlessly require consultations in person to monitor and change the disease management of patients in specific risk groups. People with diabetes represent a vulnerable population who need to be protected from avoidable outpatient clinic visits, particularly in times of influenza or other pandemic outbreaks. However, the treatment and care of patients with diabetes and its comorbidities require careful and regular monitoring and therapy adjustments by medical staff. Advanced age or cognitive impairment and insufficient access to the health care system due to low socioeconomic status can complicate the use of possible alternatives to in-person consultations in outpatient clinics or physicians' offices. Telemedicine solutions may offer suitable alternatives to standard face-to-face consultations in outpatient settings and provide sufficient access to appropriate diabetes care. Nevertheless, telemedicine methods for monitoring diabetes issues are yet to find widespread use due to numerous barriers, such as a lack of acceptance and doubt about its time- and cost-effectiveness, availability, and potential technical and regulatory issues. This article offers an overview of existing applications that provide telemedicine diabetes care. Furthermore, it discusses potential ways to restructure and revolutionize diabetes outpatient care.
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Affiliation(s)
- Felix Aberer
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
| | - Daniel A Hochfellner
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Julia K Mader
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Abstract
PURPOSE OF REVIEW The role of telehealth in the care of people with type 1 diabetes (T1D) has expanded dramatically during the coronavirus pandemic, and is expected to remain a major care delivery modality going forward. This review explores the landscape of recent evidence for telehealth in T1D care. RECENT FINDINGS Telemedicine for routine T1D care has shown equivalence to standard in-person care, with respect to glycemic control, while also increasing access, convenience, and satisfaction. Telehealth use promotes increased engagement of adolescents with T1D. Telehealth platforms have successfully been used in the care of microvascular complications and to support mental health related to diabetes. Machine learning and advanced decision support will increasingly be used to augment T1D care, as recent evidence suggests increasing capabilities to improve glycemic control. A spectrum of digital connected care services are emerging to support people with diabetes with daily management of diabetes. Finally, policy and systems are required that promote data interoperability, telemedicine provision, and reimbursement to support the ongoing growth of telehealth in T1D. SUMMARY A developing field of evidence supports use of telehealth in T1D. As this care modality scales, it has the potential to increase access to high-quality diabetes care for many people with T1D.
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Affiliation(s)
| | - Aaron B Neinstein
- Department of Medicine
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, California, USA
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Telemedicine for Pre-Employment Medical Examinations and Follow-Up Visits on Board Ships: A Narrative Review on the Feasibility. Healthcare (Basel) 2021; 9:healthcare9010069. [PMID: 33451120 PMCID: PMC7828583 DOI: 10.3390/healthcare9010069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/29/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Telemedicine has already been applied to various medical specialties for diagnosis, treatment, and follow-up visits for the general population. Telemedicine has also proven effective by providing advice, diagnosis, and treatment to seafarers during emergency medical events onboard ships. However, it has not yet been applied for pre-employment medical examinations and follow-up visits on board ships. OBJECTIVE This review aimed to assess the possibility of using telemedicine during periodic visits between one pre-employment medical examination and others on board ships, and to recommend necessary medical examination tests with screening intervals for seafarers. METHODS Various databases including PubMed, EMBASE, Scopus, CINAHL, and Cochrane Library were explored using different keywords, titles, and abstracts. Studies published between 1999 and 2019, in English, in peer-reviewed journal articles, and that are conference proceedings were considered. Finally, the studies included in this review were chosen on the basis of the eligibility criteria. RESULTS Out of a total of 168 studies, 85 studies were kept for further analysis after removing the duplicates. A further independent screening based on the inclusion and exclusion criteria resulted in the withdrawal of 51 studies that were not further considered for our analysis. Finally, 32 studies were left, which were critically reviewed. Out of 32 accepted studies, 10 studies demonstrated the effectiveness of the electrocardiogram (ECG) in monitoring and managing remote patients with heart failure, early diagnosis, and postoperative screening. In 15 studies, telespirometry was found to be effective in diagnosing and ruling out diseases, detecting lung abnormalities, and managing patients with chronic obstructive pulmonary disease (COPD) and asthma. Seven studies reported that telenephrology was effective, precise, accurate, and usable by non-medical personnel and that it reduced sample analysis times and procedures in laboratories. CONCLUSION using new technologies such as high-speed internet, video conferencing, and digital examination, personnel are able to make the necessary tests and perform virtual medical examination on board ships with necessary training.
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Algorithm for Mapping Kidney Tissue Water Content during Normothermic Machine Perfusion Using Hyperspectral Imaging. ALGORITHMS 2020. [DOI: 10.3390/a13110289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The preservation of kidneys using normothermic machine perfusion (NMP) prior to transplantation has the potential for predictive evaluation of organ quality. Investigations concerning the quantitative assessment of physiological tissue parameters and their dependence on organ function lack in this context. In this study, hyperspectral imaging (HSI) in the wavelength range of 500–995 nm was conducted for the determination of tissue water content (TWC) in kidneys. The quantitative relationship between spectral data and the reference TWC values was established by partial least squares regression (PLSR). Different preprocessing methods were applied to investigate their influence on predicting the TWC of kidneys. In the full wavelength range, the best models for absorbance and reflectance spectra provided Rp2 values of 0.968 and 0.963, as well as root-mean-square error of prediction (RMSEP) values of 2.016 and 2.155, respectively. Considering an optimal wavelength range (800–980 nm), the best model based on reflectance spectra (Rp2 value of 0.941, RMSEP value of 3.202). Finally, the visualization of TWC distribution in all pixels of kidneys’ HSI image was implemented. The results show the feasibility of HSI for a non-invasively and accurate TWC prediction in kidneys, which could be used in the future to assess the quality of kidneys during the preservation period.
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Deogon GS, Robbins T, Randeva MS, Kyrou I, Sankar S, Randeva HS, Murthy N. Managing high-acuity outpatient services during the COVID-19 pandemic: lessons from the acute diabetes foot service. Future Healthc J 2020; 7:e77-e79. [PMID: 33094262 DOI: 10.7861/fhj.2020-0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
COVID-19 has created unprecedented challenges for healthcare services internationally. Many NHS organisations have cancelled outpatient clinics to release frontline clinical staff and minimise risk of patients contracting COVID-19. While many outpatient services manage chronic diseases, a number of services manage high-acuity patients. Delivery of these acute outpatient services during the pandemic has posed particular challenges and required significant service model reconfiguration. The acute diabetes foot clinic is an important example of such a service. We explore the important lessons learnt during the COVID-19 pandemic for managing high-acuity outpatient services through the context of the diabetic foot clinic. Learning can be divided into the following categories: remote and digital working, physical changes in service delivery, workforce challenges and post-pandemic preparedness. This learning is applicable to a wide range of high-acuity services during and following the pandemic. It is particularly relevant as we expand outpatient care provision to avoid hospital admissions.
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Affiliation(s)
- Gurdev S Deogon
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), Coventry, UK
| | - Tim Robbins
- WISDEM, Coventry, UK and University of Warwick, Coventry, UK
| | | | - Ioannis Kyrou
- WISDEM, Coventry, UK, Aston University, Birmingham, UK and University of Warwick, Coventry, UK
| | - Sailesh Sankar
- WISDEM, Coventry, UK and University of Warwick, Coventry, UK
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Kim RB, Gryak J, Mishra A, Cui C, Soroushmehr SMR, Najarian K, Wrobel JS. Utilization of smartphone and tablet camera photographs to predict healing of diabetes-related foot ulcers. Comput Biol Med 2020; 126:104042. [PMID: 33059239 DOI: 10.1016/j.compbiomed.2020.104042] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/21/2020] [Accepted: 10/03/2020] [Indexed: 12/15/2022]
Abstract
The objective of this study was to build a machine learning model that can predict healing of diabetes-related foot ulcers, using both clinical attributes extracted from electronic health records (EHR) and image features extracted from photographs. The clinical information and photographs were collected at an academic podiatry wound clinic over a three-year period. Both hand-crafted color and texture features and deep learning-based features from the global average pooling layer of ResNet-50 were extracted from the wound photographs. Random Forest (RF) and Support Vector Machine (SVM) models were then trained for prediction. For prediction of eventual wound healing, the models built with hand-crafted imaging features alone outperformed models built with clinical or deep-learning features alone. Models trained with all features performed comparatively against models trained with hand-crafted imaging features. Utilization of smartphone and tablet photographs taken outside of research settings hold promise for predicting prognosis of diabetes-related foot ulcers.
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Affiliation(s)
- Renaid B Kim
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, 48109, USA.
| | - Jonathan Gryak
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, 48109, USA
| | - Abinash Mishra
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Can Cui
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, 48109, USA
| | - S M Reza Soroushmehr
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, 48109, USA
| | - Kayvan Najarian
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, 48109, USA; Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James S Wrobel
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
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Golledge J, Fernando M, Lazzarini P, Najafi B, G. Armstrong D. The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4527. [PMID: 32823514 PMCID: PMC7491197 DOI: 10.3390/s20164527] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022]
Abstract
Diabetes-related foot disease (DFD), which includes foot ulcers, infection and gangrene, is a leading cause of the global disability burden. About half of people who develop DFD experience a recurrence within one year. Long-term medical management to reduce the risk of recurrence is therefore important to reduce the global DFD burden. This review describes research assessing the value of sensors, wearables and telehealth in preventing DFD. Sensors and wearables have been developed to monitor foot temperature, plantar pressures, glucose, blood pressure and lipids. The monitoring of these risk factors along with telehealth consultations has promise as a method for remotely managing people who are at risk of DFD. This approach can potentially avoid or reduce the need for face-to-face consultations. Home foot temperature monitoring, continuous glucose monitoring and telehealth consultations are the approaches for which the most highly developed and user-friendly technology has been developed. A number of clinical studies in people at risk of DFD have demonstrated benefits when using one of these remote monitoring methods. Further development and evidence are needed for some of the other approaches, such as home plantar pressure and footwear adherence monitoring. As yet, no composite remote management program incorporating remote monitoring and the management of all the key risk factors for DFD has been developed and implemented. Further research assessing the feasibility and value of combining these remote monitoring approaches as a holistic way of preventing DFD is needed.
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Affiliation(s)
- Jonathan Golledge
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland 4814, Australia
| | - Malindu Fernando
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4000, Australia;
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland 4006, Australia
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90089, USA;
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Hutting KH, aan de Stegge WB, Kruse RR, van Baal JG, Bus SA, van Netten JJ. Infrared thermography for monitoring severity and treatment of diabetic foot infections. VASCULAR BIOLOGY (BRISTOL, ENGLAND) 2020; 2:1-10. [PMID: 32935076 PMCID: PMC7487596 DOI: 10.1530/vb-20-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Abstract
Monitoring of diabetic foot infections is largely based on clinical assessment, which is limited by moderate reliability. We conducted a prospective study to explore monitoring of thermal asymmetry (difference between mean plantar temperature of the affected and unaffected foot) for the assessment of severity of diabetic foot infections. In patients with moderate or severe diabetic foot infections (International Working Group on the Diabetic Foot infection-grades 3 or 4) we measured thermal asymmetry with an advanced infrared thermography setup during the first 4-5 days of in-hospital treatment, in addition to clinical assessments and tests of serum inflammatory markers (white blood cell counts and C-reactive protein levels). We assessed the change in thermal asymmetry from baseline to final assessment, and investigated its association with infection-grades and serum inflammatory markers. In seven included patients, thermal asymmetry decreased from median 1.8°C (range: -0.6 to 8.4) at baseline to 1.5°C (range: -0.1 to 5.1) at final assessment (P = 0.515). In three patients who improved to infection-grade 2, thermal asymmetry at baseline (median 1.6°C (range: -0.6 to 1.6)) and final assessment (1.5°C (range: 0.4 to 5.1)) remained similar (P = 0.302). In four patients who did not improve to infection-grade 2, thermal asymmetry decreased from median 4.3°C (range: 1.8 to 8.4) to 1.9°C (range: -0.1 to 4.4; P = 0.221). No correlations were found between thermal asymmetry and infection-grades (r = -0.347; P = 0.445), CRP-levels (r = 0.321; P = 0.482) or WBC (r = -0.250; P = 0.589) during the first 4-5 days of hospitalization. Based on these explorative findings we suggest that infrared thermography is of no value for monitoring diabetic foot infections during in-hospital treatment.
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Affiliation(s)
- Kor H Hutting
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
| | - Wouter B aan de Stegge
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Rombout R Kruse
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
| | - Jeff G van Baal
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
- Welsh Wound Innovation Centre, Rhodfa Marics, Ynysmaerdy, Pontyclun, UK
| | - Sicco A Bus
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Jaap J van Netten
- Department of Surgery, Hospital Group Twente, Almelo/Hengelo, the Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Dardari D, Franc S, Charpentier G, Bobony E, Demangeon L, Bouly M, Xhaard I, Orlando L, Alhajj M, Sall KL, Randazzo C, Penfornis A. Télépied Study: A Single-Centre Trial in Diabetic Subjects Comparing Total Duration of Hospitalization Over a 1-Year Period Required for Complete Healing of a Foot Ulcer Using Telemedicine Management and a Referral Nurse Versus the Standard Care Pathway. Diabetes Ther 2020; 11:1419-1427. [PMID: 32383100 PMCID: PMC7261308 DOI: 10.1007/s13300-020-00821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study is to demonstrate that the total number of days in hospital required for healing of a de novo diabetes-related foot ulcer (DFU) is lower in patients followed up using a telemedicine platform (Télépied Follow-Up group [Group 2]) than in patients followed up using standard care (Standard Follow-Up control group [Group 1]). Patients are assigned to either Group 1 or Group 2 depending on whether their first inclusion visit is during an even or odd week. Patients included in Group 1 are to be followed at spaced intervals during day hospital visits by the investigator assisted by a specialized referral nurse as part of the regular follow-up procedure (dressing changes + ulcer monitoring). Between visits, an independent nurse (IN) provides local care on a daily basis. Patients included in Group 2 have their DFU treated by a referral nurse trained at the diabetic foot unit of the investigating centre, and they are also followed up by an IN under the supervision of a referral nurse. In Group 2, monitoring of lesions is performed weekly by the referral nurse using photos of the DFU with planimetry taken by the IN and sent to the referral nurse via telemedicine software. The referral nurse can, in turn, provide guidance to the IN on the care to be provided and/or decide that a further hospital visit is needed. Both treatment groups are to be followed for 12 months or until complete healing of the ulcer. RESULTS Recruitment for the study began in March 2017 and ended in May 2019, with the final study visit scheduled for May 2020. CONCLUSION The aim of the Télépied study is to assess the impact of ambulatory foot ulcer management in diabetics over a 1-year period by a non-specialized IN working under the supervision of a referral nurse via telemedicine follow-up versus standard follow-up by an IN alone. The primary endpoint is the total duration of hospitalization required until full healing of the ulcer.
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Affiliation(s)
- Dured Dardari
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France.
- Cordeliers Research Centre INSERM U1138 "Diabetes, Metabolic Diseases and Comorbidities" Team, 15 rue de l'Ecole de Médecine, 75270, Paris cedex 06, France.
| | - Sylvia Franc
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Guillaume Charpentier
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Elise Bobony
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Laetitia Demangeon
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Marie Bouly
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
| | - Ilham Xhaard
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Laurent Orlando
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Maria Alhajj
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Kadijatou Ly Sall
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Caroline Randazzo
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Alfred Penfornis
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Saint-Aubin, France
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Roriz P, Silva S, Frazão O, Novais S. Optical Fiber Temperature Sensors and Their Biomedical Applications. SENSORS 2020; 20:s20072113. [PMID: 32283622 PMCID: PMC7180865 DOI: 10.3390/s20072113] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 01/08/2023]
Abstract
The use of sensors in the real world is on the rise, providing information on medical diagnostics for healthcare and improving quality of life. Optical fiber sensors, as a result of their unique properties (small dimensions, capability of multiplexing, chemical inertness, and immunity to electromagnetic fields) have found wide applications, ranging from structural health monitoring to biomedical and point-of-care instrumentation. Furthermore, these sensors usually have good linearity, rapid response for real-time monitoring, and high sensitivity to external perturbations. Optical fiber sensors, thus, present several features that make them extremely attractive for a wide variety of applications, especially biomedical applications. This paper reviews achievements in the area of temperature optical fiber sensors, different configurations of the sensors reported over the last five years, and application of this technology in biomedical applications.
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Affiliation(s)
- Paulo Roriz
- CIDESD (ISMAI), N2i (IPMAIA), LABIOMEP (Porto Biomechanics Laboratory), 447-690 Maia, Portugal;
| | - Susana Silva
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, Rua do Campo Alegre 687, 4169-007 Porto, Portugal; (S.S.); (S.N.)
| | - Orlando Frazão
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, Rua do Campo Alegre 687, 4169-007 Porto, Portugal; (S.S.); (S.N.)
- Department of Physics and Astronomy, Faculty of Sciences of University of Porto, Rua do Campo Alegre 687, 4169-007 Porto, Portugal
- Correspondence:
| | - Susana Novais
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, Rua do Campo Alegre 687, 4169-007 Porto, Portugal; (S.S.); (S.N.)
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Hazenberg CEVB, aan de Stegge WB, Van Baal SG, Moll FL, Bus SA. Telehealth and telemedicine applications for the diabetic foot: A systematic review. Diabetes Metab Res Rev 2020; 36:e3247. [PMID: 31808288 PMCID: PMC7079242 DOI: 10.1002/dmrr.3247] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 01/15/2023]
Abstract
The aim of this systematic review is to assess the peer-reviewed literature on the psychometric properties, feasibility, effectiveness, costs, and current limitations of using telehealth and telemedicine approaches for prevention and management of diabetic foot disease. MEDLINE/PubMed was searched for peer-reviewed studies on telehealth and telemedicine approaches for assessing, monitoring, preventing, or treating diabetic foot disease. Four modalities were formulated: dermal thermography, hyperspectral imaging, digital photographic imaging, and audio/video/online communication. Outcome measures were: validity, reliability, feasibility, effectiveness, and costs. Sixty-one studies were eligible for analysis. Three randomized controlled trials showed that handheld infrared dermal thermography as home-monitoring tool is effective in reducing ulcer recurrence risk, while one small trial showed no effect. Hyperspectral imaging has been tested in clinical settings to assess and monitor foot disease and conflicting results on its diagnostic use show that this method is still in an experimental stage. Digital photography is used to assess and monitor foot ulcers and pre-ulcerative lesions and was found to be a valid, reliable, and feasible method for telehealth purposes. Audio/video/online communication is mainly used for foot ulcer monitoring. Two randomized controlled trials show similar healing efficacy compared with regular outpatient clinic visits, but no benefit in costs. In conclusion, several technologies with good psychometric properties are available that may be of benefit in helping to assess, monitor, prevent, or treat diabetic foot disease, but in most cases, feasibility, effectiveness, and cost savings still need to be demonstrated to become accepted and used modalities in diabetic foot care.
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Affiliation(s)
| | - Wouter B. aan de Stegge
- Department of SurgeryHospital Group TwenteAlmelo/HengeloThe Netherlands
- Department of Rehabilitation MedicineAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Sjef G. Van Baal
- ZGT AcademyHospital Group TwenteAlmelo/HengeloThe Netherlands
- Cardiff UniversityCardiffWalesUK
| | - Frans L. Moll
- Department of Vascular SurgeryUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Sicco A. Bus
- Department of SurgeryHospital Group TwenteAlmelo/HengeloThe Netherlands
- Department of Rehabilitation MedicineAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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