BACKGROUND: Multiple organizations have issued guidelines to address the prevention, diagnosis and management of diabetic foot ulcers. These guidelines are based on evidence review and expert opinion. <p>METHODS: Literature review was conducted and guidelines were reviewed to identify consensus (or lack thereof) on the nature of these recommendations, the strength of the recommendations and the level of evidence.</p> <p>RESULTS: Most guidelines were not based on highest level of evidence (randomized controlled trials). A listing of recommendations for prevention, diagnosis and management was created with evidence basis for all recommendations.</p> <p>CONCLUSIONS: Areas for future research were identified among recommendations based on minimal evidence, areas of controversy, or in areas of clinical care without recommendations.</p>
Background: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk factors of chronic pain and debilitating injury. Screening has the potential to identify people at risk that may otherwise go unrecognized. This quality improvement project (QIP) aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center. Methods: A suicide risk screening QIP was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. Following training for all staff, patients ages 18 years and older were screened for suicide risk with the Ask Suicide-Screening Questions (ASQ) as standard of care. Clinic staff were surveyed about their opinions of screening. Results: Ninety-four percent of patients (442/470) agreed to be screened for suicide risk and nine patients (2%; 9/442) screened non-acute positive; zero for acute risk. The majority of clinic staff reported that they found screening acceptable, felt comfortable working with patients who have suicidal thoughts, and thought screening for suicide risk was clinically useful. Conclusions: Suicide risk screening was successfully implemented in an outpatient podiatry clinic. Screening with the ASQ provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision-making and leading to improved overall care for podiatry patients.
People suffering from diabetes are at risk of developing foot ulcerations, which, if left untreated, could also lead to amputation. Monitoring of the foot temperature can help in the prevention of these foot complications, and various studies have shown that elevated temperatures may be indicative of ulceration. Over the years there have been various devices that were designed for foot temperature monitoring, both for clinical and home use. The technologies used vary from infrared (IR) thermometry, liquid crystal thermography (LCT), IR thermography and a vast range of analogue and digital temperature sensors that were incorporated in different measurement platforms. All these systems are able to collect thermal data from the foot, some being able to acquire data only when the foot is stationary and others being able to acquire from the foot in motion, which can give a more in-depth insight to any emerging problems. The aim of this review is to evaluate the available literature related to the technologies used in these systems, outlining the benefits of each and what further developments may be required to make the foot temperature analysis more effective.
Drug based treatment of superficial fungal infections, such as onychomycosis, is not the only defense. Sanitization of footwear such as shoes, socks/stockings, and other textiles is integral to the prevention of recurrence, and reduction of spread for superficial fungal mycoses. The goal of this review was to examine the available methods of sanitization for footwear and textiles against superficial fungal infections. A systematic literature search of various sanitization devices and methods that could be applied to footwear and textiles using PubMed, Scopus, and MEDLINE was performed. Fifty-four studies were found relevant to the different methodologies, devices, and techniques of sanitization as it pertains to superficial fungal infections of the feet. These included topics of basic sanitization, antifungal and antimicrobial materials, sanitization chemicals and powder, laundering, ultraviolet, ozone, non-thermal plasma, microwave radiation, essential oils, and natural plant extracts. In management of onychomycosis it is necessary to think beyond treatment of the nail, as infections enter through the skin. Those prone to onychomycosis should examine their environment, including surfaces, shoes, and socks, and ensure that proper sanitization is implemented.
Beau M. Hawkins, Jun Li, Luke R. Wilkins, Teresa L. Carman, Amy B. Reed, David G. Armstrong, Philip Goodney, Christopher J. White, Aaron Fischman, Marc L. Schermerhorn, Dmitriy N. Feldman, Sahil A. Parikh, and Mehdi H. Shishehbor