Search

Background Diabetic foot ulcers (DFU) are complex, multifactorial and often complicated by delayed, impaired and uncoordinated wound healing. DFU are associated with devastating outcomes including infection, amputation and premature death. Aim The aim of this narrative literature review is to obtain a broad perspective on the pathophysiological mechanisms that contribute to delayed and impaired healing in the diabetic foot. Methods We undertook a review of the literature to critique and synthesise the evidence for pathophysiological factors that contribute to delayed and impaired healing in the diabetic foot. Findings It is evident from the literature that molecular mechanisms that give rise to impaired inflammation will impact upon healing, whilst physical parameters such as tissue hypoxia, pressure foot-loading, wound PH, temperature and biofilm can all contribute to delayed healing in the diabetic foot. Conclusions An understanding of the pathophysiology of impaired healing and a focus on controlling these disturbances can facilitate successful healing. To enhance the management of foot disease in diabetic patients, primary care professionals must be made aware of the significance of early referral to a specialised unit. When DFU do not heal adequately after 4 weeks of standard treatment, the underlying pathology should be re-evaluated, and the need for advanced therapy should be considered. Implications for clinical practice It is important that clinicians involved in treating DFU have an understanding of the pathophysiological mechanisms that cause delayed and impaired healing in the diabetic foot. When a DFU fails to respond to standard care within a 4-week period, the pathophysiology of the wound should be re-evaluated and advanced therapies should be considered. [ABSTRACT FROM AUTHOR]

Background Optimising wellbeing for those living with DFU is a critical component of holistic patient management. Evidence demonstrates that outcomes improve when patients are actively involved in their care. Yet, wellbeing is often overlooked for patients with DFU and there is a lack of measurement tools regarding this concept. Aim The aim of this research process was to identify--through PPI collaboration and engagement with patients--the potential for development of a wellbeing tool specifically for people living with DFU. Methods A PPI panel consisting of six members was established. The COM-B model as a framework and trigger questions on wellbeing were used as a focus for tool generation. The guidance for Reporting Involvement of Patients and the Public 2 -- Short Form (GRIPP2-SF) was used to guide the process. Findings All content was analysed using thematic analysis to map emerging themes and subthemes and create recommendations. A total of five recommendations were developed: 1. Patient education, 2. Self-efficacy, 3. Health literacy and knowledge translation, 4. Social support and 5. Holistic approach. Conclusions Further research in this area should comprehensively address the holistic elements of wellbeing to optimise outcomes for those with DFU. The development of an outcome tool for wellbeing is required to support further research. [ABSTRACT FROM AUTHOR]

Background Living with diabetic foot ulceration (DFU) can have a significant impact on a person's physical and psychological health. Clinicians involved in the treatment of DFU patients should possess sufficient knowledge and understanding of the total impact of living with a DFU, including an awareness of an individual's wellbeing. Aim To provide an overview of the current literature with regard to wellbeing in patients affected by DFU by considering current outcome measures used to assess domains of wellbeing in this population. Findings The psychological, physical, spiritual, and cultural domains of wellbeing all impact an individual's overall wellbeing. There is no one standardised tool available that assesses all four domains of wellbeing specific to those with DFU. It is important for clinicians to be aware that all members of the multidisciplinary team have a responsibility to consider the importance of wellbeing assessment and to be mindful of suggested approaches. Conclusions There is a need for a reliable and valid measurement tool to assess overall wellbeing in people living with DFU. Implications for clinical practice This review highlights the importance of the inclusion of wellbeing assessment in optimising wound care for individuals with DFU. [ABSTRACT FROM AUTHOR]

Aim: To investigate pain in patients with Diabetic foot ulcer (DFU) and its impact on their HRQOL. Method: This was a cross-sectional descriptive study, obtained sample of 30 participants from MPPC, Galway, Ireland. Pain was assessed using short-form McGill questionnaire (SF-MPQ), HRQOL was assessed Cardiff Wound Impact schedule (CWIS) questionnaire. Results / Discussion: DFU pain was reported by 70% (n=21) of participants. The majority of participants (n=16) experience "mild" to "distressing" pain, the remaining 23 % (n=5) experiencing "severe" pain. The most common sensory pain descriptors reported were "tender", "aching", and "throbbing", indicating nociceptive pain. Significant correlations between VAS and total SF-MPQ score were observed across all CWIS domains and the total CWIS score. Social life (rs=-0.710, p=<0.001) and Physical symptoms and daily living and (rs=-0.665, p=<0.001) demonstrating the strongest negative correlations. Patients with no DFU pain experience superior quality of life (Mr=22, P=0.09) compared to DFU pain where both neuropathic and nociceptive pain coexist (Mr=9, P=0.09). With statistically significant differences in the domains Social Life (Mr=22, Mr=90). The presence of DFU negatively impacts patients' health-related quality of life (HRQOL) due to many factors, one of which is pain. There is a general misconception that patients with DFU do not experience wound-related pain due to the high incidence of diabetic neuropathy among them, attributing the presence of any DFU pain to ischaemia, infection and/or Charcot arthropathy. A growing evidence base challenges previous presumptions surrounding DFU pain, reporting this as a significant factor effecting HRQOL among people with DFU. Conclusion: This study identifies classification of DFU pain as a viable contributor to the identification and implementation of effective DFU management strategies. [ABSTRACT FROM AUTHOR]

Aim: To investigate wellbeing in those who are at high risk of or living with an active diabetic foot ulcer (DFU) attending a community Podiatry clinic in the West of Ireland. Method: A total of 25 participants at risk or/ active DFUs were recruited. In addition to demographic information, Phase 1 (n = 25) assessed: Spirituality Self Rating Scale (SSRS), Hearth Hope Index (HHI), Hospital Anxiety and Depression Score (HADS), Rosenberg Self-Esteem Scale (RSES) and Powerlessness Assessment Tool (PAT). Phase 2 (n = 10) utilised a qualitative approach and explored the lived experience of those at high risk (n=4) and those living with active (n = 6) DFU through one-to-one follow-up interviews. Results / Discussion: Sixty-four percent (n=16) had current ulceration. Mean age was 69.64 (±11.47) and disease duration 21.28 years (±10.76). Male: Female gender distribution was 76% (n = 19)/ 24% (n = 6). The following mean scores were identified: SSRS 21.24 (±6.78), HHI 37.28 (±6.17), RSES 20.84 (±5.02), PAT 28.88 (±7.91), and HADS = 9 (±5.33). Individuals with current DFU presented with lower levels of self-esteem, stronger feelings of powerlessness, higher levels of depression and lower levels of anxiety when compared to those who were at risk, but not currently ulcerated. Conclusion: Participants living with current DFUs reported stronger feelings of powerlessness, lower self-esteem and higher depression scores than those who are high risk of DFUs. Those with current DFUs reported significantly lower anxiety levels compared to the high-risk group. Healthcare professionals should consider the impact that DFU may have on wellbeing and future work should investigate if addressing these factors can improve patient outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the Reposition, Inspection, Skin Care, Eat Well (R.I.S.E.) leaflet for the prevention of pressure ulcers. Topics include the need to educate informal carers of home-based pressure ulcer patients, the European Wound Management Association's (EWMA) "Home Care Wound Care" document, and the steps that led to the evolution of the final leaflet based on readability and ease of translation into other languages. Websites where the leaflet is freely available are mentioned.