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Diabetes‐related foot disease (DFD) is imposing an enormous burden on the health system and society due to the rapid growth of diabetes worldwide. Given the paucity of robust data on the disease burden of DFD in Australia, this study aimed to estimate the burden of disease due to DFD. The burden of DFD was estimated using the disability‐adjusted life‐years (DALY) approach. Data of 27 931 individuals aged 45 years and older with diabetes residing in New South Wales (NSW) from the 45 and Up Study survey were used in this study by linking it with the emergency department, hospital admissions and the deaths' registry data. The disease burden of DFD was estimated as 8915 DALY in NSW and 27 164 DALY in Australia in 2011. The burden was prominent among males and people aged 65 years and older. Most of the DALY (87%) was attributed to years of life lost or the fatal burden due to diabetes‐related lower limb amputation (DRLEA). The total monetary values of DALY of DFD for NSW and Australia were estimated at approximately AUD 2 billion and AUD 6 billion annually, respectively. Preventative and curative priorities should be given to DRLEA to reduce this burden and target males, especially those aged 65 years and older. [ABSTRACT FROM AUTHOR]

Foot ulceration is a common and devastating complication of diabetes. Traditionally, diabetic foot ulcers (DFU) are managed by multidisciplinary teams in tertiary hospital settings. Wound management decisions are based largely on visual observations at the point of care, using rudimentary evaluation of superficial tissues, such as wound tracings and photography combined with expert knowledge of the treating practitioners. Imaging based methods of assessment, such as X-ray, magnetic resonance imaging, scintigraphy or computed tomography are able to more comprehensively categorise wounds and to determine whether re-epithelialised wounds are in fact healed. Ultrasound has been advocated by the World Health Organization for the monitoring of chronic diseases and for screening because it is considered low risk, comfortable for patients and low cost. It can be performed in real time at the point of care and using B-mode, Doppler and elastography has the potential to provide clinically meaningful information for monitoring the status of hard-to-heal wounds, but to date this imaging technique has not been exploited in this field. This case series highlights the utility of diagnostic musculoskeletal ultrasound as an adjunct to traditional wound assessment that can provide diagnostically meaningful information to assist in clinical decision making. Future research will be needed to determine if routine incorporation of ultrasound in wound assessment improves patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: Wounds cost Australia nearly $3 billion a year. The aim of this study was to understand the barriers and facilitators to wound dressing selection amongst community nurses in Australia. Method: A series of semi-structured interviews (n=13) were conducted amongst nurses with experience in treating individuals with wounds (including hard-to-heal wounds). The interviews were transcribed and de-identified, then thematic analysis performed to identify key themes and subthemes. Results / Discussion: Four major themes influencing dressing selection were identified: • Industry support of clinicians • Clinician knowledge and experience • Approach to patient care • Cost and availability. Community nurses broadly agreed education and communications from wound dressing companies (suppliers) was clear, and that sales representatives were accessible for product-related information. However, adoption of supplier-provided recommendations was inconsistent within community settings. This was perceived to be due to low levels of wound management knowledge among more generalist nursing roles and lack of standardised protocols. Participants expressed that this could lead to occasional inappropriate dressing use. Lack of staff continuity across different wound services was also reported to result in inconsistent wound-management and poorer patient outcomes. Cost was implicated as a major barrier to several types of dressings, thus higher cost dressings were often not used. Conclusion: This work shows that suppliers of wound dressings clearly articulate information regarding the applications of their products. However, dressings cost may prohibit use. Dissemination of product information can be variable with some nurses not interested in current educational offerings. While the issue of cost of dressings is difficult to address, wound dressing suppliers should consider approaches to increase the reach of their communications to community nurses. [ABSTRACT FROM AUTHOR]

Aim: Online professional-education provided by industry is a key source of information for wound-care practitioners. Traditionally, this education has been delivered didactically, either face-to-face or online. A method often referred to as 'chalk-and-talk'. Accompanying visual resources, such as PowerPoint presentations inevitably have to be adapted to accommodate language preferences in individual markets. Current evidence suggests that adults learn better by building on their own experiences. Problem-based-learning (PBL) is a method where learners construct their own knowledge through identifying, analysing and solving real-world problems. This enables learners to acquire new knowledge which they can easily translate into clinical practice. Harnessing the popularity of Japanese Manga-style cartoons, the aim of this study was to develop and evaluate a visual PBL resource which could be deployed in any of the 100+ markets in which the commissioning client, an advanced wound-care company, has commercial activity. Method: Five wound-related case-scenarios were developed as Japanese style Manga cartoons (Figure 1). Each fortnight, participants collaborated in 45 minute online-discussions guided by four experts, where assessment, management and evaluation options for the scenario were discussed. Data was collected from the participants at the conclusion of the series using online polling. Results / Discussion: Analysis of feedback from participants (n=208) showed that >90% reported increased confidence in wound management. >95% agreed that PBL is an enjoyable way to learn. Conclusion: PBL is a novel and effective method of delivering professional education which can be deployed in many markets. Successful implementation of cartoon PBL represents a paradigm-shift in industry led wound education. [ABSTRACT FROM AUTHOR]

Foot ulceration is a devastating and costly consequence of diabetes. Hyperbaric oxygen therapy is recognised as an adjunctive therapy to treat diabetes‐related foot ulceration, yet uptake is low. Semi‐structured interviews were conducted with 16 podiatrists who manage patients with foot ulcers related to diabetes to explore their perceptions of, and the barriers/facilitators to, referral for hyperbaric oxygen. Podiatrists cited logistical issues such as location of facilities as well as poor communication pathways, lack of delegation and lack of follow up when patients presented for hyperbaric treatment. In general, podiatrists had an understanding of the premise of hyperbaric oxygen therapy and evidence to support its use but could only provide very limited citations of key papers and guidelines to support their position. Podiatrists stated that they felt a patient was lost from their care when referred for hyperbaric oxygen and that aftercare might not be adequate. Improved referral and delegation pathways for patients presenting for hyperbaric oxygen, as well as the provision of easily accessible evidence to support this therapy, could help to increase podiatrists’ confidence in deciding whether or not to recommend their patients for hyperbaric oxygen therapy. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes-related foot ulcers (DRFU) are a common, costly and devastating consequence of diabetes (1,2). Currently, wound management decisions are based largely on visual observations of superficial wound tissues (3). To date ultrasound has not been extensively tested in populations with DRFU'S except in a small case series (4) This study explores the ability of podiatrists to interpret ultrasound wound images. Methods: Following a short briefing session, podiatrists with previous musculoskeletal ultrasound-imaging training were asked to review a number of static sonographic images of active DRFU. Their written reports were coded and grouped into themes for analysis. Ethical approval for the study was obtained (RESP/17/49 and HERC/15/LPOOL/297) Results: Podiatrists from the UK and Australia with training in using ultrasound were consistently able to identify and describe characteristics associated with DRFU from a single wound ultrasound image. The reported findings between podiatrists was found to be similar between raters, especially in regards to bone morphology. However greater variability was seen in the reporting of more wound specific soft-tissue observations. Conclusions: This series of studies highlights the utility of ultrasound as an adjunct to traditional wound assessment which can provide diagnostically meaningful information to assist in clinical decision making. Future research will be needed to determine if routine incorporation of ultrasound to wound assessment improves patient outcomes. With the establishment of appropriate protocols and training pathways is it envisaged that moving forwards, ultrasound will be able to facilitate more timely, appropriate patient care and improve health outcomes for those with DRFU. [ABSTRACT FROM AUTHOR]