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Jan Apelqvist - One of the best experts on this subject based on the ideXlab platform.
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standards for the development and methodology of the 2019 international working group on the Diabetic Foot guidelines
Diabetes-metabolism Research and Reviews, 2020Co-Authors: Sicco A Bus, Benjamin A. Lipsky, Jan Apelqvist, Jaap J Van Netten, Robert J Hinchliffe, Nicolaas C SchaperAbstract:Diabetic Foot disease is a source of major patient suffering and societal costs. Investing in evidence-based international guidelines on Diabetic Foot disease is likely among the most cost-effective forms of health care expenditure, provided the guidelines are outcome focused, evidence based, and properly implemented. The International Working Group on the Diabetic Foot (IWGDF) has published and updated international guidelines since 1999. The 2019 updates are based on formulating relevant clinical questions and outcomes, rigorous systematic reviews of the literature, and recommendations that are specific, and unambiguous along with their transparent rationale, all using the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework. We herein describe the development of the 2019 IWGDF guidelines on the prevention and management of Diabetic Foot disease, which consists of six chapters, each prepared by a separate working group of international experts. These documents provide guidelines related to Diabetic Foot disease on prevention; offloading; peripheral artery disease; infection; wound healing interventions; and classification of Diabetic Foot ulcers. Based on these six chapters, the IWGDF Editorial Board also produced a set of practical guidelines. Each guideline underwent extensive review by the members of the IWGDF Editorial Board as well as independent international experts in each field. We believe that adoption and implementation of the 2019 IWGDF guidelines by health care providers, public health agencies, and policymakers will result in improved prevention and management of Diabetic Foot disease and a subsequent worldwide reduction in the patient and societal burden this disease causes.
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predictors of lower extremity amputation in patients with an infected Diabetic Foot ulcer
Diabetes Care, 2015Co-Authors: K Pickwell, Marleen Kars, K Bakker, Alexandra Jirkovska, Edward B Jude, Volkert Siersma, Michael Edmonds, Per Holstein, Jan Apelqvist, Didac MauricioAbstract:Infection commonly complicates Diabetic Foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected Diabetic Foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation.
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Diagnostics and treatment of the Diabetic Foot
Endocrine, 2012Co-Authors: Jan ApelqvistAbstract:Every 30 s, a lower limb is amputated due to diabetes. Of all amputations in Diabetic patients 85% are preceded by a Foot ulcer which subsequently deteriorates to a severe infection or gangrene. There is a complexity of factors related to healing of Foot ulcers including strategies for treatment of decreased perfusion, oedema, pain, infection, metabolic disturbances, malnutrition, non-weight bearing, wound treatment, Foot surgery, and management of intercurrent disease. Patients with Diabetic Foot ulcer and decreased perfusion do often not have rest pain or claudication and as a consequence non-invasive vascular testing is recommended for early recognition of ulcers in need of revascularisation to achieve healing. A Diabetic Foot infection is a potentially limb-threatening condition. Infection is diagnosed by the presence or increased rate of signs inflammation. Often these signs are less marked than expected. Imaging studies can diagnose or better define deep, soft tissue purulent collections and are frequently needed to detect pathological findings in bone. The initial antimicrobial treatment as well as duration of treatment is empiric. There is a substantial delay in wound healing in Diabetic Foot ulcer which has been related to various abnormalities. Several new treatments related to these abnormalities have been explored in wound healing with various successes. An essential part of the strategy to achieve healing is an effective offloading. Many interventions with advanced wound management have failed due to not recognizing the need for effective offloading. A multidisciplinary approach to wounds and Foot ulcer has been successfully implemented in different centres with a substantial decrease in amputation rate.
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chapter v Diabetic Foot
European Journal of Vascular and Endovascular Surgery, 2011Co-Authors: Jan Apelqvist, Carlo Setacci, M Lepantalo, J B Ricco, G De Donato, Francois Becker, Helia Robertebadi, Piergiorgio Cao, Hanshenning EcksteinAbstract:Ulcerated Diabetic Foot is a complex problem. Ischaemia, neuropathy and infection are the three pathological components that lead to Diabetic Foot complications, and they frequently occur together as an aetiologic triad. Neuropathy and ischaemia are the initiating factors, most often together as neuroischaemia, whereas infection is mostly a consequence. The role of peripheral arterial disease in Diabetic Foot has long been underestimated as typical ischaemic symptoms are less frequent in Diabetics with ischaemia than in non-Diabetics. Furthermore, the healing of a neuroischaemic ulcer is hampered by microvascular dysfunction. Therefore, the threshold for revascularising neuroischaemic ulcers should be lower than that for purely ischaemic ulcers. Previous guidelines have largely ignored these specific demands related to ulcerated neuroischaemic Diabetic feet. Any Diabetic Foot ulcer should always be considered to have vascular impairment unless otherwise proven. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve Diabetic Foot ulcer healing and to prevent amputation. Timing is essential, as the window of opportunity to heal the ulcer and save the leg is easily missed. This chapter underlines the paucity of data on the best way to diagnose and treat these Diabetic patients. Most of the studies dealing with neuroischaemic Diabetic feet are not comparable in terms of patient populations, interventions or outcome. Therefore, there is an urgent need for a paradigm shift in Diabetic Foot care; that is, a new approach and classification of Diabetics with vascular impairment in regard to clinical practice and research. A multidisciplinary approach needs to implemented systematically with a vascular surgeon as an integrated member. New strategies must be developed and implemented for Diabetic Foot patients with vascular impairment, to improve healing, to speed up healing rate and to avoid amputation, irrespective of the intervention technology chosen. Focused studies on the value of predictive tests, new treatment modalities as well as selective and targeted strategies are needed. As specific data on ulcerated neuroischaemic Diabetic feet are scarce, recommendations are often of low grade.
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the global burden of Diabetic Foot disease
The Lancet, 2005Co-Authors: Loretta Vileikyte, Andrew J M Boulton, Gunnel Ragnarsontennvall, Jan ApelqvistAbstract:Diabetic Foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes in the next 20 years. People at greatest risk of ulceration can easily be identified by careful clinical examination of the feet: education and frequent follow-up is indicated for these patients. When assessing the economic effects of Diabetic Foot disease, it is important to remember that rates of recurrence of Foot ulcers are very high, being greater than 50% after 3 years. Costing should therefore include not only the immediate ulcer episode, but also social services, home care, and subsequent ulcer episodes. A broader view of total resource use should include some estimate of quality of life and the final outcome. An integrated care approach with regular screening and education of patients at risk requires low expenditure and has the potential to reduce the cost of health care.
Benjamin A. Lipsky - One of the best experts on this subject based on the ideXlab platform.
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standards for the development and methodology of the 2019 international working group on the Diabetic Foot guidelines
Diabetes-metabolism Research and Reviews, 2020Co-Authors: Sicco A Bus, Benjamin A. Lipsky, Jan Apelqvist, Jaap J Van Netten, Robert J Hinchliffe, Nicolaas C SchaperAbstract:Diabetic Foot disease is a source of major patient suffering and societal costs. Investing in evidence-based international guidelines on Diabetic Foot disease is likely among the most cost-effective forms of health care expenditure, provided the guidelines are outcome focused, evidence based, and properly implemented. The International Working Group on the Diabetic Foot (IWGDF) has published and updated international guidelines since 1999. The 2019 updates are based on formulating relevant clinical questions and outcomes, rigorous systematic reviews of the literature, and recommendations that are specific, and unambiguous along with their transparent rationale, all using the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework. We herein describe the development of the 2019 IWGDF guidelines on the prevention and management of Diabetic Foot disease, which consists of six chapters, each prepared by a separate working group of international experts. These documents provide guidelines related to Diabetic Foot disease on prevention; offloading; peripheral artery disease; infection; wound healing interventions; and classification of Diabetic Foot ulcers. Based on these six chapters, the IWGDF Editorial Board also produced a set of practical guidelines. Each guideline underwent extensive review by the members of the IWGDF Editorial Board as well as independent international experts in each field. We believe that adoption and implementation of the 2019 IWGDF guidelines by health care providers, public health agencies, and policymakers will result in improved prevention and management of Diabetic Foot disease and a subsequent worldwide reduction in the patient and societal burden this disease causes.
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treating Diabetic Foot osteomyelitis primarily with surgery or antibiotics have we answered the question
Diabetes Care, 2014Co-Authors: Benjamin A. LipskyAbstract:Foot infections are among the most frequent diabetes-related causes for hospitalization and the usual immediate predecessor to lower-extremity amputation in these patients (1). Infection usually starts in ulcerated soft tissues, but can spread contiguously to underlying bone (2). Overall, about 20% of patients with a Diabetic Foot infection (and over 60% of those with severe infections [3]) have underlying osteomyelitis, which dramatically increases the risk of lower-extremity amputation (4). Indeed, optimally managing Diabetic Foot osteomyelitis is widely considered the most difficult and controversial aspect of dealing with Diabetic Foot infections (5–7). In the preantibiotic era, the only option for treating osteomyelitis was surgical resection of all necrotic and infected bone. Because surgeons feared further spread of infection up the limb in what was then called “Diabetic gangrene,” most procedures were major (often above the knee) amputations (8). The advent of antibiotic therapy led to a marked reduction in both mortality (9–11) and need for major amputations (10,11) in patients with Diabetic Foot infections. Antibiotic therapy was largely considered adjunctive to surgery, but in the past two decades reports appeared of patients with Diabetic Foot osteomyelitis apparently cured by antibiotic therapy with little or no surgical resection (12), leading some to reexamine the belief that surgery was almost always needed for this form of chronic osteomyelitis (13). There are potential advantages, as well as disadvantages, to both medical and surgical treatment of Diabetic Foot osteomyelitis (Table 1). In some clinical situations, it is clear that one or the other approach is most appropriate (Table 2), but in most cases the …
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inpatient management of Diabetic Foot disorders a clinical guide
Diabetes Care, 2013Co-Authors: Dane K Wukich, Benjamin A. Lipsky, Andrew J M Boulton, David Armstrong, Christopher E Attinger, Patrick R Burns, Robert G Frykberg, Richard Hellman, Paul J Kim, James C PileAbstract:The implementation of an inpatient Diabetic Foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with Diabetic Foot disorders, and optimize the transition from inpatient to outpatient care. Essential skills that are required for an inpatient team include the ability to stage a Foot wound, assess for peripheral vascular disease, neuropathy, wound infection, and the need for debridement; appropriately culture a wound and select antibiotic therapy; provide, directly or indirectly, for optimal metabolic control; and implement effective discharge planning to prevent a recurrence. Diabetic Foot ulcers may be present in patients who are admitted for nonFoot problems, and these ulcers should be evaluated by the Diabetic Foot team during the hospitalization. Pathways should be in place for urgent or emergent treatment of Diabetic Foot infections and neuropathic fractures/dislocations. Surgeons involved with these patients should have knowledge and interest in limb preservation techniques. Prevention of iatrogenic Foot complications, such as pressure sores of the heel, should be a priority in patients with diabetes who are admitted for any reason: all hospitalized Diabetic patients require a clinical Foot exam on admission to identify risk factors such as loss of sensation or ischemia. Appropriate posthospitalization monitoring to reduce the risk of reulceration and infection should be available, which should include optimal glycemic control and correction of any fluid and electrolyte disturbances.
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concordance in Diabetic Foot ulcer infection
BMJ Open, 2013Co-Authors: Andrea E Nelson, Michael R Backhouse, Moninder S Bhogal, Alexandra Wrighthughes, Benjamin A. Lipsky, Jane Nixon, Sarah Brown, Janine GrayAbstract:Introduction Accurate identification of pathogens, rather than colonising bacteria, is a prerequisite for targeted antibiotic therapy to ensure optimal patient outcome in wounds, such as Diabetic Foot ulcers. Wound swabs are the easiest and most commonly used sampling technique but most published guidelines recommend instead removal of a tissue sample from the wound bed, which is a more complex process. The aim of this study was to assess the concordance between culture results from wound swabs and tissue samples in patients with suspected Diabetic Foot infection. Methods and analysis Patients with a Diabetic Foot ulcer that is thought to be infected are being recruited from 25 sites across England in a cross-sectional study. The coprimary endpoints for the study are agreement between the two sampling techniques for three microbiological parameters: reported presence of likely isolates identified by the UK Health Protection Agency; resistance of isolates to usual antibiotic agents; and, the number of isolates reported per specimen. Secondary endpoints include appropriateness of the empiric antibiotic therapy prescribed and adverse events. Enrolling 400 patients will provide 80% power to detect a difference of 3% in the reported presence of an organism, assuming organism prevalence of 10%, discordance of 5% and a two-sided test at the 5% level of significance. Assumed overall prevalence is based on relatively uncommon organisms such as Pseudomonas . We will define acceptable agreement as κ>0.6. Ethics and dissemination Concordance in Diabetic Foot ulcer infection (CODIFI) will produce robust data to evaluate the two most commonly used sampling techniques employed for patients with a Diabetic Foot infection. This will help determine whether or not it is important that clinicians take tissue samples rather than swabs in infected ulcers. This study has been approved by the Sheffield NRES Committee (Ref: 11/YH/0078) and all sites have obtained local approvals prior starting recruitment. Study registration NRES Ref: 11/YH/0078, UKCRN ID: 10440, ISRCTN: 52608451
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expert opinion on the management of infections in the Diabetic Foot
Diabetes-metabolism Research and Reviews, 2012Co-Authors: Benjamin A. Lipsky, E Senneville, Edgar J G Peters, Lawrence A Lavery, Anthony R Berendt, John M Embil, Vilma Urbancicrovan, W J JeffcoateAbstract:Summary This update of the International Working Group on the Diabetic Foot incorporates some information from a related review of Diabetic Foot osteomyelitis (DFO) and a systematic review of the management of infection of the Diabetic Foot. The pathophysiology of these infections is now well understood, and there is a validated system for classifying the severity of infections based on their clinical findings. Diagnosing osteomyelitis remains difficult, but several recent publications have clarified the role of clinical, laboratory and imaging tests. Magnetic resonance imaging has emerged as the most accurate means of diagnosing bone infection, but bone biopsy for culture and histopathology remains the criterion standard. Determining the organisms responsible for a Diabetic Foot infection via culture of appropriately collected tissue specimens enables clinicians to make optimal antibiotic choices based on culture and sensitivity results. In addition to culture-directed antibiotic therapy, most infections require some surgical intervention, ranging from minor debridement to major resection, amputation or revascularization. Clinicians must also provide proper wound care to ensure healing of the wound. Various adjunctive therapies may benefit some patients, but the data supporting them are weak. If properly treated, most Diabetic Foot infections can be cured. Providers practising in developing countries, and their patients, face especially challenging situations. Copyright © 2012 John Wiley & Sons, Ltd.
Andrew J M Boulton - One of the best experts on this subject based on the ideXlab platform.
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Diabetic Foot Ulcers and Their Recurrence
The New England Journal of Medicine, 2017Co-Authors: David G Armstrong, Andrew J M BoultonAbstract:Foot ulceration is the most common lower-extremity complication in patients with diabetes mellitus. This review considers the pathogenesis, treatment, and management of Diabetic Foot ulcers, including prevention of recurrence.
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computer vision algorithms in the detection of Diabetic Foot ulceration a new paradigm for Diabetic Foot care
Journal of diabetes science and technology, 2016Co-Authors: Moi Hoon Yap, Katie E Chatwin, C A Abbott, Frank L Bowling, Andrew J M Boulton, Neil D ReevesAbstract:Diabetic Foot ulcers (DFUs) and other Foot pathologies are highly prevalent in people with diabetes, especially in patients with the secondary complications of peripheral neuropathy and/or peripheral vascular disease.1 The development of DFUs involves changes in the appearance of the Foot over time, however, many subtle changes in Foot shape, texture, and color will likely be undetectable by human vision until a DFU is established. Advanced computer vision algorithms have been applied in the medical field to detect subtle signs to differentiate the type of tumours2 subtle changes in facial features—such as fine wrinkles on the face3 and micro facial movements4—where some of these features are not detectable by human vision. We see the opportunity to apply computer vision algorithms to help in the early detection of key pathological changes in the Diabetic Foot leading to the development of a DFU.
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inpatient management of Diabetic Foot disorders a clinical guide
Diabetes Care, 2013Co-Authors: Dane K Wukich, Benjamin A. Lipsky, Andrew J M Boulton, David Armstrong, Christopher E Attinger, Patrick R Burns, Robert G Frykberg, Richard Hellman, Paul J Kim, James C PileAbstract:The implementation of an inpatient Diabetic Foot service should be the goal of all institutions that care for patients with diabetes. The objectives of this team are to prevent problems in patients while hospitalized, provide curative measures for patients admitted with Diabetic Foot disorders, and optimize the transition from inpatient to outpatient care. Essential skills that are required for an inpatient team include the ability to stage a Foot wound, assess for peripheral vascular disease, neuropathy, wound infection, and the need for debridement; appropriately culture a wound and select antibiotic therapy; provide, directly or indirectly, for optimal metabolic control; and implement effective discharge planning to prevent a recurrence. Diabetic Foot ulcers may be present in patients who are admitted for nonFoot problems, and these ulcers should be evaluated by the Diabetic Foot team during the hospitalization. Pathways should be in place for urgent or emergent treatment of Diabetic Foot infections and neuropathic fractures/dislocations. Surgeons involved with these patients should have knowledge and interest in limb preservation techniques. Prevention of iatrogenic Foot complications, such as pressure sores of the heel, should be a priority in patients with diabetes who are admitted for any reason: all hospitalized Diabetic patients require a clinical Foot exam on admission to identify risk factors such as loss of sensation or ischemia. Appropriate posthospitalization monitoring to reduce the risk of reulceration and infection should be available, which should include optimal glycemic control and correction of any fluid and electrolyte disturbances.
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depression predicts first but not recurrent Diabetic Foot ulcers
Diabetologia, 2010Co-Authors: Jeffrey S Gonzalez, Loretta Vileikyte, Jan S Ulbrecht, Richard R Rubin, A Garrow, C Delgado, Peter R Cavanagh, Andrew J M BoultonAbstract:Aims/hypothesis This study examined the relationship between symptoms of depression and the development of Diabetic Foot ulcers.
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the Diabetic Foot grand overview epidemiology and pathogenesis
Diabetes-metabolism Research and Reviews, 2008Co-Authors: Andrew J M BoultonAbstract:This review assesses the progress that has been made over the last quarter century in our understanding of the pathogenesis of Diabetic Foot problems as well as in their management. Some recent exciting developments are highlighted. This is followed by a brief discussion on the epidemiology and causal pathways to Diabetic Foot disease.
W J Jeffcoate - One of the best experts on this subject based on the ideXlab platform.
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cost of Diabetic Foot disease to the national health service in england
Diabetic Medicine, 2014Co-Authors: Marion Kerr, G Rayman, W J JeffcoateAbstract:Aim To estimate the annual cost of Diabetic Foot care in a universal healthcare system. Methods National datasets and economic modelling were used to estimate the cost of Diabetic Foot disease to the National Health Service in England in 2010–2011. The cost of hospital admissions specific to Foot disease or amputation was estimated from Hospital Episode Statistics and national tariffs. Multivariate regression analysis was used to estimate the impact of Foot disease on length of stay in admissions that were not specific to Foot disease or amputation. Costs in other areas were estimated from published studies and data from individual hospitals. Results The cost of Diabetic Foot care in 2010–2011 is estimated at £580m, almost 0.6% of National Health Service expenditure in England. We estimate that more than half this sum (£307m) was spent on care for ulceration in primary and community settings. Of hospital admissions with recorded diabetes, 8.8% included ulcer care or amputation. Regression analysis suggests that Foot disease was associated with a 2.51-fold (95% CI 2.43–2.59) increase in length of stay.The cost of inpatient ulcer care is estimated at £219 m, and that of amputation care at £55 m. Conclusions The cost of Diabetic Foot disease is substantial. Ignorance of the cost of current care may hinder commissioning of effective services for prevention and management in both community and secondary care.
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expert opinion on the management of infections in the Diabetic Foot
Diabetes-metabolism Research and Reviews, 2012Co-Authors: Benjamin A. Lipsky, E Senneville, Edgar J G Peters, Lawrence A Lavery, Anthony R Berendt, John M Embil, Vilma Urbancicrovan, W J JeffcoateAbstract:Summary This update of the International Working Group on the Diabetic Foot incorporates some information from a related review of Diabetic Foot osteomyelitis (DFO) and a systematic review of the management of infection of the Diabetic Foot. The pathophysiology of these infections is now well understood, and there is a validated system for classifying the severity of infections based on their clinical findings. Diagnosing osteomyelitis remains difficult, but several recent publications have clarified the role of clinical, laboratory and imaging tests. Magnetic resonance imaging has emerged as the most accurate means of diagnosing bone infection, but bone biopsy for culture and histopathology remains the criterion standard. Determining the organisms responsible for a Diabetic Foot infection via culture of appropriately collected tissue specimens enables clinicians to make optimal antibiotic choices based on culture and sensitivity results. In addition to culture-directed antibiotic therapy, most infections require some surgical intervention, ranging from minor debridement to major resection, amputation or revascularization. Clinicians must also provide proper wound care to ensure healing of the wound. Various adjunctive therapies may benefit some patients, but the data supporting them are weak. If properly treated, most Diabetic Foot infections can be cured. Providers practising in developing countries, and their patients, face especially challenging situations. Copyright © 2012 John Wiley & Sons, Ltd.
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Diabetic Foot ulcers
The Lancet, 2003Co-Authors: W J Jeffcoate, Keith HardingAbstract:Summary Ulceration of the Foot in diabetes is common and disabling and frequently leads to amputation of the leg. Mortality is high and healed ulcers often recur. The pathogenesis of Foot ulceration is complex, clinical presentation variable, and management requires early expert assessment. Interventions should be directed at infection, peripheral ischaemia, and abnormal pressure loading caused by peripheral neuropathy and limited joint mobility. Despite treatment, ulcers readily become chronic wounds. Diabetic Foot ulcers have been neglected in health-care research and planning, and clinical practice is based more on opinion than scientific fact. Furthermore, the pathological processes are poorly understood and poorly taught and communication between the many specialties involved is disjointed and insensitive to the needs of patients. Published online Feb 25,2003 http://image.thelancet.com/extras/02art6190web.pdf
Sicco A Bus - One of the best experts on this subject based on the ideXlab platform.
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standards for the development and methodology of the 2019 international working group on the Diabetic Foot guidelines
Diabetes-metabolism Research and Reviews, 2020Co-Authors: Sicco A Bus, Benjamin A. Lipsky, Jan Apelqvist, Jaap J Van Netten, Robert J Hinchliffe, Nicolaas C SchaperAbstract:Diabetic Foot disease is a source of major patient suffering and societal costs. Investing in evidence-based international guidelines on Diabetic Foot disease is likely among the most cost-effective forms of health care expenditure, provided the guidelines are outcome focused, evidence based, and properly implemented. The International Working Group on the Diabetic Foot (IWGDF) has published and updated international guidelines since 1999. The 2019 updates are based on formulating relevant clinical questions and outcomes, rigorous systematic reviews of the literature, and recommendations that are specific, and unambiguous along with their transparent rationale, all using the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework. We herein describe the development of the 2019 IWGDF guidelines on the prevention and management of Diabetic Foot disease, which consists of six chapters, each prepared by a separate working group of international experts. These documents provide guidelines related to Diabetic Foot disease on prevention; offloading; peripheral artery disease; infection; wound healing interventions; and classification of Diabetic Foot ulcers. Based on these six chapters, the IWGDF Editorial Board also produced a set of practical guidelines. Each guideline underwent extensive review by the members of the IWGDF Editorial Board as well as independent international experts in each field. We believe that adoption and implementation of the 2019 IWGDF guidelines by health care providers, public health agencies, and policymakers will result in improved prevention and management of Diabetic Foot disease and a subsequent worldwide reduction in the patient and societal burden this disease causes.
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infrared thermal imaging for automated detection of Diabetic Foot complications
Journal of diabetes science and technology, 2013Co-Authors: Jaap J Van Netten, Jeff G Van Baal, Chanjuan Liu, Ferdi Van Der Heijden, Sicco A BusAbstract:Background: Although thermal imaging can be a valuable technology in the prevention and management of Diabetic Foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of Diabetic Foot disease. Conclusions: With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of Diabetic Foot disease and to discriminate between no, local, or diffuse Diabetic Foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of Diabetic Foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings.
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infrared thermal imaging for automated detection of Diabetic Foot complications
Faculty of Health, 2013Co-Authors: Jaap J Van Netten, Jeff G Van Baal, Chanjuan Liu, Ferdi Van Der Heijden, Sicco A BusAbstract:Background Although thermal imaging can be a valuable technology in the prevention and management of Diabetic Foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of Diabetic Foot disease. Methods The plantar Foot surfaces of 15 diabetes patients were imaged with an infrared camera (resolution, 1.2 mm/pixel): 5 patients had no visible signs of Foot complications, 5 patients had local complications (e.g., abundant callus or neuropathic ulcer), and 5 patients had difuse complications (e.g., Charcot Foot, infected ulcer, or critical ischemia). Foot temperature was calculated as mean temperature across pixels for the whole Foot and for specified regions of interest (ROIs). Results No diferences in mean temperature >1.5 °C between the ipsilateral and the contralateral Foot were found in patients without complications. In patients with local complications, mean temperatures of the ipsilateral and the contralateral Foot were similar, but temperature at the ROI was >2 °C higher compared with the corresponding region in the contralateral Foot and to the mean of the whole ipsilateral Foot. In patients with difuse complications, mean temperature diferences of >3 °C between ipsilateral and contralateral Foot were found. Conclusions With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of Diabetic Foot disease and to discriminate between no, local, or difuse Diabetic Foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of Diabetic Foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings.