Initial and continued adherence to wearing appropriate footwear in people with diabetic foot disease: results of a pilot study

Background: For the prevention and healing of diabetic foot ulcers, appropriate footwear or medical devices are utilized. However, initial and continued adherence of patients with diabetes-related foot problems in using such therapeutic means, is not satisfactory. bjective: To explore initial and continued adherence to wearing appropriate footwear in people with diabetic foot disease. Methods: A cross-sectional study was conducted, from March to November 2016, at general and special hospitals in Athens, Greece. Forty-one outpatients with type 1 and 2 Diabetes Mellitus, with medical recommendation for wearing appropriate footwear, participated. A structured quantitative interview guide and medical measuring instruments were used. For data analysis, descriptive and inferential statistic methods were applied using the IBM SPSS 24 software package. Results: Suitable for diabetes footwear were worn from the 56.1% of participants. The 27.3% of risk patients wore their preventive shoes ≥60% (≥9.6 hours) of daytime. The patients with active foot ulcers wore appropriate footwear at a lesser percentage than the ones at risk (44.4% versus 78.6%, χ2(1) =4.36, p=0.037; OR 4.58, 95% CI 1.04-20.24, p=0.045) and the initially adherent group had significantly subordinate Visual Analogue Scale score in relation to the satisfaction from the footwear price (Mdn=5.00) than the one that was not initially adherent (Mdn=8.00), U=97.00, z=-2.36, p=0.019, r=-.38. Conclusion: For the enhancement of initial and continued adherence in wearing appropriate footwear, health care professionals could pay more attention to the education of patients with active foot ulcers, underling the importance of using right shoes. Additionally, they could provide patients with multiple price options concerning their footwear (e.g. by suggesting effective and affordable products)

The Impressive Healing Power of Autologous Fibroblasts Isolated from Early Cultures of Skin Biopsies for the Treatment of Diabetic Foot Ulcers: Preliminary Results Regarding 2 Cases

Aims: The purpose of this study was to investigate whether we can quickly, effectively, and with relatively low cost, heal long-standing (>8 months) diabetic foot ulcers using autologous skin fibroblasts. Place and Duration of Study: Immunology & National Histocompatibility Department and 2nd Department of Surgery, ‘G. Gennimatas’ General Hospital, ‘Demetrios Voyatzoglou’ Diabetic Foot Clinic, ‘A. Fleming’ General Hospital, Department of Biology, National and Kapodistrian University of Athens, Athens, Greece, between June 2011 and May 2012. Study Design and Methodology: Early, autologous skin fibroblasts arisen in large numbers from small split-thickness skin biopsies, cultured in high concentration of fetal bovine serum, and dispersed in patients΄ own serum, were injected subcutaneously into the surrounding healthy tissue of uninfected diabetic foot ulcers of two type 2 diabetic patients without peripheral angiopathy. Results: There was complete healing in 11 and 27 weeks in patients 1 & 2, respectively. The early cultured fibroblasts showed impressive healing power for diabetic foot ulcers. On the contrary, the power of the prolonged cultured fibroblast diminished steadily, while the fibroblasts undergone the freezing-thawing procedure were not effective. Conclusion: The healing was complete, quick, safe, permanent, without scars or hyperkeratosis, and relatively inexpensive

Point-prevalence survey of healthcare facility-onset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study.

The correlation of Clostridium difficile infection (CDI) with in-hospital morbidity is important in hospital settings where broad-spectrum antimicrobial agents are routinely used, such as in Greece. The C. DEFINE study aimed to assess point-prevalence of CDI in Greece during two study periods in 2013.There were two study periods consisting of a single day in March and another in October 2013. Stool samples from all patients hospitalized outside the ICU aged ≥18 years old with diarrhea on each day in 21 and 25 hospitals, respectively, were tested for CDI. Samples were tested for the presence of glutamate dehydrogenase antigen (GDH) and toxins A/B of C. difficile; samples positive for GDH and negative for toxins were further tested by culture and PCR for the presence of toxin genes. An analysis was performed to identify potential risk factors for CDI among patients with diarrhea.5,536 and 6,523 patients were screened during the first and second study periods, respectively. The respective point-prevalence of CDI in all patients was 5.6 and 3.9 per 10,000 patient bed-days whereas the proportion of CDI among patients with diarrhea was 17% and 14.3%. Logistic regression analysis revealed that solid tumor malignancy [odds ratio (OR) 2.69, 95% confidence interval (CI): 1.18-6.15, p = 0.019] and antimicrobial administration (OR 3.61, 95% CI: 1.03-12.76, p = 0.045) were independent risk factors for CDI development. Charlson's Comorbidity Index (CCI) >6 was also found as a risk factor of marginal statistical significance (OR 2.24, 95% CI: 0.98-5.10). Median time to CDI from hospital admission was shorter with the presence of solid tumor malignancy (3 vs 5 days; p = 0.002) and of CCI >6 (4 vs 6 days, p = 0.009).The point-prevalence of CDI in Greek hospitals was consistent among cases of diarrhea over a 6-month period. Major risk factors were antimicrobial use, solid tumor malignancy and a CCI score >6

Point-prevalence survey of healthcare facility-onset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study.

The correlation of Clostridium difficile infection (CDI) with in-hospital morbidity is important in hospital settings where broad-spectrum antimicrobial agents are routinely used, such as in Greece. The C. DEFINE study aimed to assess point-prevalence of CDI in Greece during two study periods in 2013.There were two study periods consisting of a single day in March and another in October 2013. Stool samples from all patients hospitalized outside the ICU aged ≥18 years old with diarrhea on each day in 21 and 25 hospitals, respectively, were tested for CDI. Samples were tested for the presence of glutamate dehydrogenase antigen (GDH) and toxins A/B of C. difficile; samples positive for GDH and negative for toxins were further tested by culture and PCR for the presence of toxin genes. An analysis was performed to identify potential risk factors for CDI among patients with diarrhea.5,536 and 6,523 patients were screened during the first and second study periods, respectively. The respective point-prevalence of CDI in all patients was 5.6 and 3.9 per 10,000 patient bed-days whereas the proportion of CDI among patients with diarrhea was 17% and 14.3%. Logistic regression analysis revealed that solid tumor malignancy [odds ratio (OR) 2.69, 95% confidence interval (CI): 1.18-6.15, p = 0.019] and antimicrobial administration (OR 3.61, 95% CI: 1.03-12.76, p = 0.045) were independent risk factors for CDI development. Charlson's Comorbidity Index (CCI) >6 was also found as a risk factor of marginal statistical significance (OR 2.24, 95% CI: 0.98-5.10). Median time to CDI from hospital admission was shorter with the presence of solid tumor malignancy (3 vs 5 days; p = 0.002) and of CCI >6 (4 vs 6 days, p = 0.009).The point-prevalence of CDI in Greek hospitals was consistent among cases of diarrhea over a 6-month period. Major risk factors were antimicrobial use, solid tumor malignancy and a CCI score >6

Comparative characteristics of patients with diarrhea with and without <i>Clostridium difficile</i> infection (CDI).

<p>Comparative characteristics of patients with diarrhea with and without <i>Clostridium difficile</i> infection (CDI).</p

Study flow chart for each study period.

<p>CDI: <i>Clostridium difficile</i> infection</p

Primary and secondary variables of point-prevalence of each phase of the study.

<p>Primary and secondary variables of point-prevalence of each phase of the study.</p

Logistic regression analysis of risk factors related to <i>Clostridium difficile</i> infection among patients with diarrhea.

<p>Logistic regression analysis of risk factors related to <i>Clostridium difficile</i> infection among patients with diarrhea.</p

Cox regression analysis of variables associated with time until development of CDI.

<p>Cox regression analysis of variables associated with time until development of CDI.</p