The assessment and management of diabetes related lower limb problems in India - an action research approach to integrating best practice

Background: In this article the authors explore the current issues and barriers related to achieving successful outcomes to diabetic foot complications in India. This was achieved by engaging clinicians in taking ownership of the problems and facilitating them in the identification of solutions to action change in clinical practice. Methods: This was accomplished through facilitating participants in this study via a process of problem identification and planning, the first phases of an action research cycle approach. The methods of data collection were focus groups, observations and individual conversations. The data were analysed using a thematic framework. Findings: Based on the practitioner's experiences and opinions, key themes were identified. These themes had the potential to inform the changes needed in clinical practice, to overcome barriers and embed ownership of the solutions. Five themes were identified highlighting: concerns over a fragmented service; local recognition of need; lack of standardised care pathways; lack of structured assessment and an absence of annual foot screening. Combined, the issues identified were thought to be important in preventing timely assessment and management of foot problems. Conclusion: It was unanimously agreed that a formalised process of foot assessment should be developed and implemented as part of the subsequent phases of the action research process, which the authors intended to take forward and report in a further paper. The aim of which is to guide triage, education, care pathways, audit and evaluation of outcomes. Facilitation of the clinicians in developing a program and screening tool to implement and teach these skills to others could be an important step in reducing the number of high-risk cases that are often resulting in the amputation of limbs

High Resolution Ultrasonic Attenuation Measurement in Pulse-echo Setup

In the present work, a new technique for ultrasonic attenuation measurement in pulse echo setup is designed using off the shelf components. The technique is based on the comparison of echo amplitudes with a programmable reference voltage generated by the personal computer. The designed circuit can measure the echo amplitudes up to seven echoes with a resolution of 4mV, which is sufficient for estimation of ultrasonic attenuation. It does not require the fast analog to digital converters. A program has been developed in "C" to record echo amplitudes and display ultrasonic attenuation on screen. The instrument developed is a stand alone system and does not require any other instrument except PC. The developed technique has been tested for its functionality on some standard liquids

Evaluation of efficacy and safety of gliclazide in NIDDM patients who failed to respond to glibanclamide therapy

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