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Aims: Principles of wound management, including debridement, wound bed preparation, and newer technologies involving alternation of wound physiology to facilitate healing, are of utmost importance when attempting to heal a chronic diabetes‐related foot ulcer. However, the rising incidence and costs of diabetes‐related foot ulcer management necessitate that interventions to enhance wound healing of chronic diabetes‐related foot ulcers are supported by high‐quality evidence of efficacy and cost effectiveness when used in conjunction with established aspects of gold‐standard multidisciplinary care. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence‐based guideline on wound healing interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline. Materials and Methods: We followed the GRADE approach by devising clinical questions and important outcomes in the Patient‐Intervention‐Control‐Outcome (PICO) format, undertaking a systematic review, developing summary of judgements tables, and writing recommendations and rationale for each question. Each recommendation is based on the evidence found in the systematic review and, using the GRADE summary of judgement items, including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability, we formulated recommendations that were agreed by the authors and reviewed by independent experts and stakeholders. Results: From the results of the systematic review and evidence‐to‐decision making process, we were able to make 29 separate recommendations. We made a number of conditional supportive recommendations for the use of interventions to improve healing of foot ulcers in people with diabetes. These include the use of sucrose octasulfate dressings, the use of negative pressure wound therapies for post‐operative wounds, the use of placental‐derived products, the use of the autologous leucocyte/platelet/fibrin patch, the use of topical oxygen therapy, and the use of hyperbaric oxygen. Although in all cases it was stressed that these should be used where best standard of care was not able to heal the wound alone and where resources were available for the interventions. Conclusions: These wound healing recommendations should support improved outcomes for people with diabetes and ulcers of the foot, and we hope that widescale implementation will follow. However, although the certainty of much of the evidence on which to base the recommendations is improving, it remains poor overall. We encourage not more, but better quality trials including those with a health economic analysis, into this area. [ABSTRACT FROM AUTHOR]

In this paper we describe a method for exploring young children's views of illness causality in social context. Studies of children's conceptualisation of illness have predominantly focused on the nature of children's knowledge rather than locating that knowledge within socio-cultural contexts. Adopting a socio-constructivist perspective we sought to identify the ways in which young children's illness causality concepts are embedded in the socio-cultural context of the family. Interviews were undertaken with four-year-old children, their parents/guardians, sibling/s aged five to nine years and two other family members. To aid the elicitation of young children's narrative accounts of illness causality, children were invited to construct a storybook about "getting sick" utilising art materials and photographs of children experiencing illness. In this paper we describe this method, discuss its utility in eliciting illness narratives from pre-school children and provide suggestions for the use of this method in future research.

A study was conducted to examine monolithic-microwave integrated-circuit source-impedance tuners for on-wafer noise-parameter measurement systems. The tuners can eliminate the effect of cable and probe losses on the reflection coefficient. They can also be connected directly to a test device on-wafer. In addition, the tuners incorporate large usable bandwidths and can be synthesized up to 50 different discrete impedance points.

Autonomic neuropathy in the diabetic foot is associated with decreased sweating, loss of skin temperature regulation and interruption of sympathetic nerve function. The associated sudomotor dysfunction can cause anhidrosis in the feet, leading to callus, fissures or ulceration. There is no internationally recommended or recognised standardised tool to diagnose sudomotor dysfunction in the lower limb, and it is also unclear if currently available tools validly measure anhidrosis. This study investigates associations between clinician-observed anhidrosis, Neuropad®-detected anhidrosis and Michigan Neuropathy Screening Instrument (MNSI) findings in a sample of 50 participants with diabetes who attended a community podiatry service in the West of Ireland. Diabetic peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument and Neuropad. The clinician-observed anhidrosis did not correlate with MNSI or Neuropad findings. [ABSTRACT FROM AUTHOR]

Abstract Background Randomised controlled trials are widely accepted as the gold standard method to evaluate medical interventions, but they are still open to bias. One such bias is the effect of patient’s preference on outcome measures. The aims of this study were to examine whether patients’ treatment preference affected clearance of plantar warts and explore whether there were any associations between patients’ treatment preference and baseline variables in the EverT trial. Methods Two hundred and forty patients were recruited from University podiatry schools, NHS podiatry clinics and primary care. Patients were aged 12 years and over and had at least one plantar wart which was suitable for treatment with salicylic acid and cryotherapy. Patients were asked their treatment preference prior to randomisation. The Kruskal-Wallis test was performed to test the association between preference group and continuous baseline variables. The Fisher’s exact test was performed to test the association between preference group and categorical baseline variables. A logistic regression analysis was undertaken with verruca clearance (yes or no) as the dependent variable and treatment, age, type of verruca, previous treatment, treatment preference as independent variables. Two analyses were undertaken, one using the health professional reported outcome and one using the patient’s self reported outcomes. Data on whether the patient found it necessary to stop the treatment to which they had been allocated and whether they started another treatment were summarised by treatment group. Results Pre-randomisation preferences were: 10% for salicylic acid; 42% for cryotherapy and 48% no treatment preference. There was no evidence of an association between treatment preference group and either patient (p=0.95) or healthcare professional (p=0.46) reported verruca clearance rates. There was no evidence of an association between preference group and any of the baseline variables except gender, with more females expressing a preference for salicylic acid (p=0.004). There was no evidence that the number of times salicylic acid was applied was different between the preference groups at one week (p=0.89) or at three weeks (p=0.24). Similarly, for the number of clinic visits for cryotherapy (p=0.71) Conclusions This secondary analysis showed no evidence to suggest that patients’ baseline preferences affected verruca clearance rates or adherence with the treatment. Trial registration Current Controlled Trials ISRCTN18994246 and National Research Register N0484189151

Abstract Background Plantar warts (verrucae) are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid and cryotherapy using liquid nitrogen being two of the most common forms of treatment. To date, no full economic evaluation of either salicylic acid or cryotherapy has been conducted based on the use of primary data in a pragmatic setting. This paper describes the cost-effectiveness analysis which was conducted alongside a pragmatic multicentre, randomised trial evaluating the clinical effectiveness of cryotherapy versus 50% salicylic acid of the treatment of plantar warts. Methods A cost-effectiveness analysis was undertaken alongside a pragmatic multicentre, randomised controlled trial assessing the clinical effectiveness of 50% salicylic acid and cryotherapy using liquid nitrogen at 12 weeks after randomisation of patients. Cost-effectiveness outcomes were expressed as the additional cost required to completely cure the plantar warts of one additional patient. A NHS perspective was taken for the analysis. Results Cryotherapy costs on average £101.17 (bias corrected and accelerated (BCA) 95% CI: 85.09-117.26) more per participant over the 12 week time-frame, while there is no additional benefit, in terms of proportion of patients healed compared with salicylic acid. Conclusions Cryotherapy is more costly and no more effective than salicylic acid. Trial registration Current Controlled Trials ISRCTN18994246 [controlled-trials.com] and National Research Register N0484189151.

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]

Effective management of wound exudate in diabetic foot ulcers (DFUs) is a key component of any wound management plan and crucial to facilitate the healing of DFUs. It is important, therefore, that clinicians involved in the management of DFUs understand the role and function of wound exudate and, importantly, can recognise when exudate can become detrimental to the healing process. This article provides an overview of wound exudate, its role and constituents, and outlines current best practice in managing wound exudate to best facilitate wound healing and wound closure in DFUs. [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]