21 research outputs found
Management of peripheral arterial disease in diabetes: a national survey of podiatry practice in the United Kingdom
Background
We aimed to investigate podiatry practice in diagnosing peripheral arterial disease (PAD) in diabetes, decision making once PAD is suspected and limitations of referral pathways.
Methods
A survey, comprising 26 questions was distributed to podiatrists across the UK via mailing lists of collaborating organizations including the College of Podiatry (UK). Response rates were estimated based on NHS workforce data. Analysis of responses from the open-ended questions was performed using inductive content analysis.
Results
Data from 283 respondents were analyzed. Response rate for all NHS podiatrists across the UK was estimated to be 6%. For the detection of arterial disease only 18.8% (n = 49/260) of participants reported using a full combination of history, pulse palpation, Doppler and ABPI assessment. Self-reported confidence in detecting arterial disease was highest amongst podiatrists who felt they had received adequate training compared to podiatrists who felt they had not (median 85 (IQR 75–90) vs 67 (50–77), respectively; p 20 diabetic patients per week compared to those who see < 20 (median 80 (IQR 70–90) vs 72 (60–82.8), respectively; p < 0.001). Over one third of respondents (35.8%, n = 93/260) were aware of missed cases of PAD in the past year and 17.5% (n = 38/217) believed that this resulted in an amputation in some cases.
The survey highlighted a lack of clarity amongst podiatrists regarding referral guidelines. Additionally, 69% (n = 169/242) reported that their patients had to wait longer than 2-weeks for specialist vascular assessment and 67.6% (n = 54/80) reported similar waits for a Duplex Ultrasound scan. There was a statistically significant variation in DUS waiting time across the UK (X2 (10, N = 80) = 21.59, p = 0.017). Inability to make a direct referral to vascular services and long delays were reported as major limitations of the referral pathway.
Conclusion
We have identified important targets for further investigation and quality improvement
The Role of Wearable Technologies and Telemonitoring in Managing Vascular Disease
Wearable devices and telemonitoring are becoming increasingly widespread in the clinical environment and have many applications in the tracking and maintenance of patient wellbeing. Interventions incorporating these technologies have been used with some success in patients with vascular disorders. Wearable fitness monitors and telemonitoring have been used in the community to mobilise patients with peripheral vascular disease with good results. Additionally, wearable monitors and telemonitoring have been studied for blood pressure monitoring in patients with hypertension. Telemonitoring interventions incorporating electronic medication trays and ingestible sensors have also been found to increase drug adherence in hypertensive patients and ultimately improve health outcomes. However, wearable and telemonitoring interventions often face problems with patient adherence, digital literacy and infrastructure. Further work needs to address these challenges and validate the technology before widespread implementation can occur
Evaluating the diagnostic and triage performance of digital and online symptom checkers for the presentation of myocardial infarction; A retrospective cross-sectional study
Online symptom checkers are increasingly popular health technologies that enable patients to input their symptoms to produce diagnoses and triage advice. However, there is concern regarding the performance and safety of symptom checkers in diagnosing and triaging patients with life-threatening conditions. This retrospective cross-sectional study aimed to evaluate and compare commercially available symptom checkers for performance in diagnosing and triaging myocardial infarctions (MI). Symptoms and biodata of MI patients were inputted into 8 symptom checkers identified through a systematic search. Anonymised clinical data of 100 consecutive MI patients were collected from a tertiary coronary intervention centre between 1st January 2020 to 31st December 2020. Outcomes included (1) diagnostic sensitivity as defined by symptom checkers outputting MI as the primary diagnosis (D1), or one of the top three (D3), or top five diagnoses (D5); and (2) triage sensitivity as defined by symptom checkers outputting urgent treatment recommendations. Overall D1 sensitivity was 48±31% and varied between symptom checkers (range: 6–85%). Overall D3 and D5 sensitivity were 73±20% (34–92%) and 79±14% (63–94%), respectively. Overall triage sensitivity was 83±13% (55–91%). 24±16% of atypical cases had a correct D1 though for female atypical cases D1 sensitivity was only 10%. Atypical MI D3 and D5 sensitivity were 44±21% and 48±24% respectively and were significantly lower than typical MI cases (p<0.01). Atypical MI triage sensitivity was significantly lower than typical cases (53±20% versus 84±15%, p<0.01). Female atypical cases had significantly lower diagnostic and triage sensitivity than typical female MI cases (p<0.01).Given the severity of the pathology, the diagnostic performance of symptom checkers for correctly diagnosing an MI is concerningly low. Moreover, there is considerable inter-symptom checker performance variation. Patients presenting with atypical symptoms were under-diagnosed and under-triaged, especially if female. This study highlights the need for improved clinical performance, equity and transparency associated with these technologies
Study protocol for a multicentre comparative diagnostic accuracy study of tools to establish the presence and severity of peripheral arterial disease in people with diabetes mellitus: the DM PAD study
Introduction Peripheral arterial disease (PAD) is a key risk
factor for cardiovascular disease, foot ulceration and lower
limb amputation in people with diabetes. Early diagnosis of
PAD can enable optimisation of therapies to manage these
risks. Its diagnosis is fundamental, though challenging in
the context of diabetes. Although a variety of diagnostic
bedside tests are available, there is no agreement as to
which is the most accurate in routine clinical practice.
The aim of this study is to determine the diagnostic
performance of a variety of tests (audible waveform
assessment, visual waveform assessment, ankle brachial
pressure index (ABPI), exercise ABPI and toe brachial
pressure index (TBPI)) for the diagnosis of PAD in people
with diabetes as determined by a reference test (CT
angiography (CTA) or magnetic resonance angiography
(MRA)). In selected centres, we also aim to evaluate the
performance of a new point-of-
care
duplex ultrasound
scan (PAD-scan).
Methods and analysis A prospective multicentre
diagnostic accuracy study ( ClinicalTrials. gov Identifier
NCT05009602). We aim to recruit 730 people with
diabetes from 18 centres across the UK, covering primary
and secondary healthcare. Consenting participants will
undergo the tests under investigation. Reference tests
(CTA or MRA) will be performed within 6 weeks of the
index tests. Imaging will be reported by blinded consultant
radiologists at a core imaging lab, using a validated
scoring system, which will also be used to categorise PAD
severity. The presence of one or more arterial lesions of
≥50% stenosis, or tandem lesions with a combined value
of ≥50%, will be used as the threshold for the diagnosis
of PAD. The primary outcome measure of diagnostic
performance will be test sensitivity.
Ethics and dissemination The study has received
approval from the National Research Ethics Service (NRES)
(REC reference 21/PR/1221). Results will be disseminated
through research presentations and papers.National Institute for Health Research (NIHR) NIHR131855NIHR Clinical Lectureship
NIHR Imperial Biomedical Research Centre (BRC
Pathogenesis of Distal Symmetrical Polyneuropathy in Diabetes.
Distal symmetrical polyneuropathy (DSPN) is a serious complication of diabetes associated with significant disability and mortality. Although more than 50% of people with diabetes develop DSPN, its pathogenesis is still relatively unknown. This lack of understanding has limited the development of novel disease-modifying therapies and left the reasons for failed therapies uncertain, which is critical given that current management strategies often fail to achieve long-term efficacy. In this article, the pathogenesis of DSPN is reviewed, covering pathogenic changes in the peripheral nervous system, microvasculature and central nervous system (CNS). Furthermore, the successes and limitations of current therapies are discussed, and potential therapeutic targets are proposed. Recent findings on its pathogenesis have called the definition of DSPN into question and transformed the disease model, paving the way for new research prospects
A Pilot Study of Heart Rate Variability Synchrony as a Marker of Intraoperative Surgical Teamwork and Its Correlation to the Length of Procedure
Objective: Quality of intraoperative teamwork may have a direct impact on patient outcomes. Heart rate variability (HRV) synchrony may be useful for objective assessment of team cohesion and good teamwork. The primary aim of this study was to investigate the feasibility of using HRV synchrony in surgical teams. Secondary aims were to investigate the association of HRV synchrony with length of procedure (LOP), complications, number of intraoperative glitches and length of stay (LOS). We also investigated the correlation between HRV synchrony and team familiarity, pre- and intraoperative stress levels (STAI questionnaire), NOTECHS score and experience of team members. Methods: Ear, nose and throat (ENT) and vascular surgeons (consultant and registrar team members) were recruited into the study. Baseline demographics including level of team members’ experience were gathered before each procedure. For each procedure, continuous electrocardiogram (ECG) recording was performed and questionnaires regarding pre- and intraoperative stress levels and non-technical skills (NOTECHS) scores were collected for each team member. An independent observer documented the time of each intraoperative glitch. Statistical analysis was conducted using stepwise multiple linear regression. Results: Four HRV synchrony metrics which may be markers of efficient surgical collaboration were identified from the data: 1. number of HRV synchronies per hour of procedure, 2. number of HRV synchrony trends per hour of procedure, 3. length of HRV synchrony trends per hour of procedure, 4. area under the HRV synchrony trend curve per hour of procedure. LOP was inversely correlated with number of HRV synchrony trends per hour of procedure (p p = 0.001), length of HRV synchrony trends per hour of procedure (p = 0.002) and number of HRV synchronies per hour of procedure (p p = 0.043; R = 0.358) and intraoperative STAI score of the whole team (p = 0.007; R = 0.493). Conclusions: HRV synchrony metrics within operating teams may be used as an objective marker to quantify surgical teamwork. We have shown that LOP is shorter when the intraoperative surgical teams’ HRV is more synchronised
Prevention and Management Strategies for Diabetic Neuropathy.
Diabetic neuropathy (DN) is a common complication of diabetes that is becoming an increasing concern as the prevalence of diabetes rapidly rises. There are several types of DN, but the most prevalent and studied type is distal symmetrical polyneuropathy, which is the focus of this review and is simply referred to as DN. It can lead to a wide range of sensorimotor and psychosocial symptoms and is a major risk factor for diabetic foot ulceration and Charcot neuropathic osteoarthropathy, which are associated with high rates of lower limb amputation and mortality. The prevention and management of DN are thus critical, and clinical guidelines recommend several strategies for these based on the best available evidence. This article aims to provide a narrative review of DN prevention and management strategies by discussing these guidelines and the evidence that supports them. First, the epidemiology and diverse clinical manifestations of DN are summarized. Then, prevention strategies such as glycemic control, lifestyle modifications and footcare are discussed, as well as the importance of early diagnosis. Finally, neuropathic pain management strategies and promising novel therapies under investigation such as neuromodulation devices and nutraceuticals are reviewed
Factors Affecting Engagement in Web-Based Health Care Patient Information: Narrative Review of the Literature
BackgroundWeb-based content is rapidly becoming the primary source of health care information. There is a pressing need for web-based health care content to not only be accurate but also be engaging. Improved engagement of people with web-based health care content has the potential to inform as well as influence behavioral change to enable people to make better health care choices. The factors associated with better engagement with web-based health care content have previously not been considered.
ObjectiveThe aims of this study are to identify the factors that affect engagement with web-based health care content and develop a framework to be considered when creating such content.
MethodsA comprehensive search of the PubMed and MEDLINE database was performed from January 1, 1946, to January 5, 2020. The reference lists of all included studies were also searched. The Medical Subject Headings database was used to derive the following keywords: “patient information,” “online,” “internet,” “web,” and “content.” All studies in English pertaining to the factors affecting engagement in web-based health care patient information were included. No restrictions were set on the study type. Analysis of the themes arising from the results was performed using inductive content analysis.
ResultsThe search yielded 814 articles, of which 56 (6.9%) met our inclusion criteria. The studies ranged from observational and noncontrolled studies to quasi-experimental studies. Overall, there was significant heterogeneity in the types of interventions and outcome assessments, which made quantitative assessment difficult. Consensus among all authors of this study resulted in six categories that formed the basis of a framework to assess the factors affecting engagement in web-based health care content: easy to understand, support, adaptability, accessibility, visuals and content, and credibility and completeness.
ConclusionsThere is a paucity of high-quality data relating to the factors that improve the quality of engagement with web-based health care content. Our framework summarizes the reported studies, which may be useful to health care content creators. An evaluation of the utility of web-based content to engage users is of significant importance and may be accessible through tools such as the Net Promoter score. Web 3.0 technology and development of the field of psychographics for health care offer further potential for development. Future work may also involve improvement of the framework through a co-design process