The Experts below are selected from a list of 9558 Experts worldwide ranked by ideXlab platform

Michael P Dillon - One of the best experts on this subject based on the ideXlab platform.

  • A systematic review describing incidence rate and prevalence of dysvascular partial Foot Amputation; how both have changed over time and compare to transtibial Amputation
    Systematic reviews, 2017
    Co-Authors: Michael P Dillon, Matthew Quigley, Stefania Fatone
    Abstract:

    Partial Foot Amputation (PFA) is a common consequence of advanced peripheral vascular disease. Given the different ways incidence rate and prevalence data have been measured and reported, it is difficult to synthesize data and reconcile variation between studies. As such, there is uncertainty in whether the incidence rates and prevalence of PFA have increased over time compared to the decline in transtibial Amputation (TTA). The aims of this systematic review were to describe the incidence rate and prevalence of dysvascular PFA over time, and how these compare to TTA. Databases (i.e., MEDLINE, EMBASE, psychINFO, AMED, CINAHL, ProQuest Nursing and Allied Health) were searched using MeSH terms and keywords related to Amputation level and incidence rate or prevalence. Original research published in English from 1 January 2000 to 31 December 2015 were independently appraised, and data extracted, by two reviewers. The McMaster Critical Review Forms were used to assess methodological quality and bias. Results were reported as narrative summaries given heterogeneity of the literature and included the weighted mean annual incidence rate and 95% confidence interval. Twenty two cohort studies met the inclusion criteria. Twenty one reported incidence rate data for some level of PFA; four also included a TTA cohort. One study reported prevalence data for a cohort with toe(s) Amputation. Samples were typically older, male and included people with diabetes among other comorbidities. Incidence rates were reported using a myriad of denominators and strata such as diabetes type or initial/recurrent Amputation. When appropriately grouped by denominator and strata, incidence rates were more homogenous than might be expected. Variation between studies did not necessarily reduce confidence in the conclusion; for example, incidence rate of PFA were many times larger in cohorts with diabetes (94.24 per 100,000 people with diabetes; 95% CI 55.50 to 133.00) compared to those without (3.80 per 100,000 people without diabetes; 95% CI 1.43 to 6.16). It is unclear whether the incidence rates of PFA have changed over time or how they have changed relative to TTA. Further research requires datasets that include a large number of Amputations each year and lengthy time periods to determine whether small annual changes in incidence rates have a cumulative and statistically significant effect over time. PROSPERO CRD42015029186 .

  • Outcomes of dysvascular partial Foot Amputation and how these compare to transtibial Amputation: a systematic review for the development of shared decision-making resources
    Systematic reviews, 2017
    Co-Authors: Michael P Dillon, Matthew Quigley, Stefania Fatone
    Abstract:

    Dysvascular partial Foot Amputation (PFA) is a common sequel to advanced peripheral vascular disease. Helping inform difficult discussions between patients and practitioners about the level of PFA, or the decision to have a transtibial Amputation (TTA) as an alternative, requires an understanding of the current research evidence on a wide range of topics including wound healing, reAmputation, quality of life, mobility, functional ability, participation, pain and psychosocial outcomes, and mortality. The aim of this review was to describe a comprehensive range of outcomes of dysvascular PFA and compare these between levels of PFA and TTA. The review protocol was registered in PROSPERO (CRD42015029186). A systematic search of the literature was conducted using MEDLINE, EMBASE, psychINFO, AMED, CINAHL, ProQuest Nursing and Allied Health, and Web of Science. These databases were searched using MeSH terms and keywords relating to different Amputation levels and outcomes of interest. Peer reviewed studies of original research—irrespective of the study design—were included if published in English between 1 January 2000, and 31 December 2015, and included discrete cohort(s) with dysvascular PFA or PFA and TTA. Outcomes of interest were rate of wound healing and complications, rate of ipsilateral reAmputation, quality of life, functional ability, mobility, pain (i.e., residual limb or phantom pain), psychosocial outcomes (i.e., depression, anxiety, body image and self-esteem), participation, and mortality rate. Included studies were independently appraised by two reviewers. The McMaster Critical Review Forms were used to assess methodological quality and identify sources of bias. Data were extracted based on the Cochrane Consumers and Communication Review Group’s data extraction template by a primary reviewer and checked for accuracy and clarity by a second reviewer. Findings are reported as narrative summaries given the heterogeneity of the literature, except for mortality and ipsilateral reAmputation where data allowed for proportional meta-analyses. Twenty-nine unique articles were included in the review, acknowledging that some studies reported multiple outcomes. Eighteen studies reported all-cause proportionate mortality. A smaller number of studies reported outcomes related to functional ability (two), mobility (four), quality of life (three), ipsilateral reAmputation (six) as well as wound healing and complications (four). No studies related to pain, participation or psychosocial outcomes met the inclusion criteria. Subjects were typically older and male and had diabetes among other comorbidities. More detailed information about the cohorts such as race or sociodemographic factors were reported in an ad hoc manner. Common sources of bias included contamination, co-intervention, or lack of operational definition for some outcomes (e.g., wound healing) as illustrative examples. Aside from mortality, there was limited evidence regarding outcomes of dysvascular PFA, particularly how outcomes differ between levels of PFA and TTA. Acknowledging that there is considerable uncertainty given the small body of literature on many topics where the risk of bias is high, the available evidence suggests that a large proportion of people with PFA experience delayed wound healing and ipsilateral reAmputation. People with TTA have increased risk of mortality compared to those with PFA, which may reflect that those considered suitable candidates for TTA have more advanced systemic disease that also increases the risk of dying. Mobility and quality of life may be similar in people with PFA and TTA. CRD42015029186

  • Describe the outcomes of dysvascular partial Foot Amputation and how these compare to transtibial Amputation: a systematic review protocol for the development of shared decision-making resources.
    Systematic reviews, 2015
    Co-Authors: Michael P Dillon, Stefania Fatone, Matthew Quigley
    Abstract:

    Helping people make well-informed decisions about dysvascular partial Foot Amputation is becoming increasingly important as improvements in diabetes care and vascular surgery make more distal Amputations increasingly possible. The high rates of complications and reAmputations associated with partial Foot Amputation are of concern, particularly given that transtibial Amputation seems to result in similar outcomes (e.g., mobility and quality of life) with comparatively few complications and reAmputations. The aim of this review is to describe the outcomes of dysvascular partial Foot Amputation and compare these to transtibial Amputation. Results from the review are intended for use in the development of shared decision-making resources. A comprehensive range of databases—MEDLINE, EMBASE, PsycINFO, AMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Nursing and Allied Health, and Web of Science—will be searched using National Library of Medicine, Medical Subject Headings (MeSH) terms as well as title, abstract, and keywords relating to different Amputation levels and outcomes of interest; specifically: incidence, prevalence, and rate of Amputation; rate of mortality, wound failure, dehiscence, and time between index and ipsilateral reAmputations; and mobility, functional ability, activity and participation, quality of life, pain, and psychosocial outcomes including depression and anxiety. Articles that meet the inclusion criteria will be hand-searched for relevant citations. A forward citation search using Google Scholar will be used to identify articles not yet indexed. Original research published in the English language after 1 January 2000 will be included. The McMaster Critical Review Forms will be used to assess methodological quality and identify sources of bias. Included articles will be independently appraised by two reviewers. Data will be extracted using a spreadsheet based on the Cochrane Consumers and Communication Review Group’s data extraction template by a primary reviewer and checked for accuracy and clarity by a second reviewer. Findings from the review will be reported as a narrative without meta-analysis given the anticipated heterogeneity of the literature. Results from the review can be used in the design of shared decision-making resources to help inform difficult decisions about partial Foot Amputation. PROSPERO CRD42015029186

  • Deliberations About the Functional Benefits and Complications of Partial Foot Amputation: Do We Pay Heed to the Purported Benefits at the Expense of Minimizing Complications?
    Archives of physical medicine and rehabilitation, 2013
    Co-Authors: Michael P Dillon, Stefania Fatone
    Abstract:

    While discussion about the benefits and complications of partial Foot Amputation (PFA) is not new, much of it has hinged on anecdotal evidence and led to the popular view that the risk of complications and secondary Amputation is reasonable when weighed against the perceived benefits associated with maintaining the ankle joint and residual Foot length, including more normal walking, reduced energy expenditure, and improved quality of life. The research evidence makes it difficult not to question whether these benefits are valid and worth striving to achieve. When you consider that persons who undergo PFA are typically in the later years of their life and have limited mobility, it raises the question of whether we place too much emphasis on achieving the purported functional benefits of PFA and too little emphasis on achieving primary wound healing and mitigating the high rates of complications and subsequent Amputation. If further research supports what we see emerging in the evidence, there will be a case to be made for selecting the level of PFA based primarily on the potential for wound healing, rather than trying to strike a balance with the perceived functional benefits. This may mean that transtibial Amputation is preferable in many cases, given the lower rates of complications and secondary Amputation, very similar function in terms of walking and energy expenditure, and similar lived experience of limb loss when compared with persons with PFA. Further research is needed to better understand the complications and benefits of PFA to make this a more viable, first-and-final Amputation procedure.

  • Influence of marker models on ankle kinematics in persons with partial Foot Amputation: an investigation using a mechanical model.
    Journal of rehabilitation research and development, 2008
    Co-Authors: Michael P Dillon, Andrew H. Hansen, Stefania Fatone
    Abstract:

    INTRODUCTION A systematic review on the biomechanics of gait in persons with partial Foot Amputation (PFA) concluded that there was a high level of evidence that PFA affects the temporospatial, external force, kinematic, kinetic, and plantar pressure aspects of PFA gait, but there was less confidence in the evidence regarding exactly how these aspects of gait were affected [1]. Dillon et al. suggested that a number of methodological problems endemic in this body of literature reduced confidence in the evidence [1]. For example, with the exception of two studies [2-3], marker placement was not explicitly described [4-6], which is problematic because marker placement defines the kinematic measurements. Since most authors reported using commercially available systems to collect these data [4-6], one can only assume that they followed the standard marker placement procedures required of those systems. However, most of the studies did not describe how certain markers were placed in the presence of a prosthesis or the absence of the foreFoot landmarks typically used to locate some of the markers defining the Foot local coordinate system. Given these sorts of methodological issues, it is not surprising that the ankle kinematic data vary markedly between investigations. Concerns have been raised regarding the accuracy of these data, especially with respect to discrepancies between bareFoot and shod/ device investigations [1]. Previous studies of bareFoot walking in PFA suggest that ankle dorsiflexion range is either reduced or similar to that observed in persons without Amputation. Garabolsa et al. observed significantly less dorsiflexion of the residuum during gait compared with the sound limb in a group of persons with dysvascular transmetatarsal (TMT) Amputation [3]. Boyd et al. investigated groups of persons with dysvascular Amputation with either toe, metatarsophalangeal (MTP), or ray Amputations, but how many toes or rays were affected in these groups was unclear [5]. No significant differences existed in ankle dorsiflexion between groups of subjects with Amputation and a control group of nondisabled subjects who walked more quickly. Unclear descriptions of Amputation level [5] make comparison between these studies difficult and walking velocity was either not reported [3] or expressed as a proportion of a laboratory normal database [5]. Hence, accounting for the influence of walking speed between investigations was not possible. Tang et al. reported bareFoot kinematics for a group of individuals with "mostly traumatic" TMT Amputation as part of an experimental study comparing gait in several conditions, including bareFoot, shoe only, or shoe plus prosthesis (insole with carbon fiber Footplate) [4]. The dorsiflexion peak observed in the control group was similar to that seen in the PFA bareFoot walking condition despite some dorsiflexion bias in the PFA group. Such bias of the kinematic data raises concerns about the modeling and changing of markers between experimental conditions. When the total ankle range from initial plantar flexion peak to dorsiflexion peak is considered, the PFA subjects walking bareFoot exhibited reduced angular excursion compared with the control group [4]. In contrast to the relatively normal or reduced ankle dorsiflexion observed during bareFoot ambulation in PFA, studies measuring ankle motion in shoe or shoe plus prosthesis conditions suggest that ankle dorsiflexion is increased. Tang et al. reported that for a group of individuals with TMT Amputation, the shoe and shoe plus prosthesis conditions allowed significantly greater ankle dorsiflexion during stance compared with walking bareFoot or a shod control group [4]. An observational study by Dillon reported a similar pattern of ankle movement in persons with Lisfranc and TMT Amputation using either toe fillers, slipper sockets, or shoes stuffed with a variety of materials, but the dorsiflexion range and peak were more normal and comparable with the 95 percent confidence interval of the control group [7]. …

Stefania Fatone - One of the best experts on this subject based on the ideXlab platform.

  • A systematic review describing incidence rate and prevalence of dysvascular partial Foot Amputation; how both have changed over time and compare to transtibial Amputation
    Systematic reviews, 2017
    Co-Authors: Michael P Dillon, Matthew Quigley, Stefania Fatone
    Abstract:

    Partial Foot Amputation (PFA) is a common consequence of advanced peripheral vascular disease. Given the different ways incidence rate and prevalence data have been measured and reported, it is difficult to synthesize data and reconcile variation between studies. As such, there is uncertainty in whether the incidence rates and prevalence of PFA have increased over time compared to the decline in transtibial Amputation (TTA). The aims of this systematic review were to describe the incidence rate and prevalence of dysvascular PFA over time, and how these compare to TTA. Databases (i.e., MEDLINE, EMBASE, psychINFO, AMED, CINAHL, ProQuest Nursing and Allied Health) were searched using MeSH terms and keywords related to Amputation level and incidence rate or prevalence. Original research published in English from 1 January 2000 to 31 December 2015 were independently appraised, and data extracted, by two reviewers. The McMaster Critical Review Forms were used to assess methodological quality and bias. Results were reported as narrative summaries given heterogeneity of the literature and included the weighted mean annual incidence rate and 95% confidence interval. Twenty two cohort studies met the inclusion criteria. Twenty one reported incidence rate data for some level of PFA; four also included a TTA cohort. One study reported prevalence data for a cohort with toe(s) Amputation. Samples were typically older, male and included people with diabetes among other comorbidities. Incidence rates were reported using a myriad of denominators and strata such as diabetes type or initial/recurrent Amputation. When appropriately grouped by denominator and strata, incidence rates were more homogenous than might be expected. Variation between studies did not necessarily reduce confidence in the conclusion; for example, incidence rate of PFA were many times larger in cohorts with diabetes (94.24 per 100,000 people with diabetes; 95% CI 55.50 to 133.00) compared to those without (3.80 per 100,000 people without diabetes; 95% CI 1.43 to 6.16). It is unclear whether the incidence rates of PFA have changed over time or how they have changed relative to TTA. Further research requires datasets that include a large number of Amputations each year and lengthy time periods to determine whether small annual changes in incidence rates have a cumulative and statistically significant effect over time. PROSPERO CRD42015029186 .

  • Outcomes of dysvascular partial Foot Amputation and how these compare to transtibial Amputation: a systematic review for the development of shared decision-making resources
    Systematic reviews, 2017
    Co-Authors: Michael P Dillon, Matthew Quigley, Stefania Fatone
    Abstract:

    Dysvascular partial Foot Amputation (PFA) is a common sequel to advanced peripheral vascular disease. Helping inform difficult discussions between patients and practitioners about the level of PFA, or the decision to have a transtibial Amputation (TTA) as an alternative, requires an understanding of the current research evidence on a wide range of topics including wound healing, reAmputation, quality of life, mobility, functional ability, participation, pain and psychosocial outcomes, and mortality. The aim of this review was to describe a comprehensive range of outcomes of dysvascular PFA and compare these between levels of PFA and TTA. The review protocol was registered in PROSPERO (CRD42015029186). A systematic search of the literature was conducted using MEDLINE, EMBASE, psychINFO, AMED, CINAHL, ProQuest Nursing and Allied Health, and Web of Science. These databases were searched using MeSH terms and keywords relating to different Amputation levels and outcomes of interest. Peer reviewed studies of original research—irrespective of the study design—were included if published in English between 1 January 2000, and 31 December 2015, and included discrete cohort(s) with dysvascular PFA or PFA and TTA. Outcomes of interest were rate of wound healing and complications, rate of ipsilateral reAmputation, quality of life, functional ability, mobility, pain (i.e., residual limb or phantom pain), psychosocial outcomes (i.e., depression, anxiety, body image and self-esteem), participation, and mortality rate. Included studies were independently appraised by two reviewers. The McMaster Critical Review Forms were used to assess methodological quality and identify sources of bias. Data were extracted based on the Cochrane Consumers and Communication Review Group’s data extraction template by a primary reviewer and checked for accuracy and clarity by a second reviewer. Findings are reported as narrative summaries given the heterogeneity of the literature, except for mortality and ipsilateral reAmputation where data allowed for proportional meta-analyses. Twenty-nine unique articles were included in the review, acknowledging that some studies reported multiple outcomes. Eighteen studies reported all-cause proportionate mortality. A smaller number of studies reported outcomes related to functional ability (two), mobility (four), quality of life (three), ipsilateral reAmputation (six) as well as wound healing and complications (four). No studies related to pain, participation or psychosocial outcomes met the inclusion criteria. Subjects were typically older and male and had diabetes among other comorbidities. More detailed information about the cohorts such as race or sociodemographic factors were reported in an ad hoc manner. Common sources of bias included contamination, co-intervention, or lack of operational definition for some outcomes (e.g., wound healing) as illustrative examples. Aside from mortality, there was limited evidence regarding outcomes of dysvascular PFA, particularly how outcomes differ between levels of PFA and TTA. Acknowledging that there is considerable uncertainty given the small body of literature on many topics where the risk of bias is high, the available evidence suggests that a large proportion of people with PFA experience delayed wound healing and ipsilateral reAmputation. People with TTA have increased risk of mortality compared to those with PFA, which may reflect that those considered suitable candidates for TTA have more advanced systemic disease that also increases the risk of dying. Mobility and quality of life may be similar in people with PFA and TTA. CRD42015029186

  • Describe the outcomes of dysvascular partial Foot Amputation and how these compare to transtibial Amputation: a systematic review protocol for the development of shared decision-making resources.
    Systematic reviews, 2015
    Co-Authors: Michael P Dillon, Stefania Fatone, Matthew Quigley
    Abstract:

    Helping people make well-informed decisions about dysvascular partial Foot Amputation is becoming increasingly important as improvements in diabetes care and vascular surgery make more distal Amputations increasingly possible. The high rates of complications and reAmputations associated with partial Foot Amputation are of concern, particularly given that transtibial Amputation seems to result in similar outcomes (e.g., mobility and quality of life) with comparatively few complications and reAmputations. The aim of this review is to describe the outcomes of dysvascular partial Foot Amputation and compare these to transtibial Amputation. Results from the review are intended for use in the development of shared decision-making resources. A comprehensive range of databases—MEDLINE, EMBASE, PsycINFO, AMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Nursing and Allied Health, and Web of Science—will be searched using National Library of Medicine, Medical Subject Headings (MeSH) terms as well as title, abstract, and keywords relating to different Amputation levels and outcomes of interest; specifically: incidence, prevalence, and rate of Amputation; rate of mortality, wound failure, dehiscence, and time between index and ipsilateral reAmputations; and mobility, functional ability, activity and participation, quality of life, pain, and psychosocial outcomes including depression and anxiety. Articles that meet the inclusion criteria will be hand-searched for relevant citations. A forward citation search using Google Scholar will be used to identify articles not yet indexed. Original research published in the English language after 1 January 2000 will be included. The McMaster Critical Review Forms will be used to assess methodological quality and identify sources of bias. Included articles will be independently appraised by two reviewers. Data will be extracted using a spreadsheet based on the Cochrane Consumers and Communication Review Group’s data extraction template by a primary reviewer and checked for accuracy and clarity by a second reviewer. Findings from the review will be reported as a narrative without meta-analysis given the anticipated heterogeneity of the literature. Results from the review can be used in the design of shared decision-making resources to help inform difficult decisions about partial Foot Amputation. PROSPERO CRD42015029186

  • Deliberations About the Functional Benefits and Complications of Partial Foot Amputation: Do We Pay Heed to the Purported Benefits at the Expense of Minimizing Complications?
    Archives of physical medicine and rehabilitation, 2013
    Co-Authors: Michael P Dillon, Stefania Fatone
    Abstract:

    While discussion about the benefits and complications of partial Foot Amputation (PFA) is not new, much of it has hinged on anecdotal evidence and led to the popular view that the risk of complications and secondary Amputation is reasonable when weighed against the perceived benefits associated with maintaining the ankle joint and residual Foot length, including more normal walking, reduced energy expenditure, and improved quality of life. The research evidence makes it difficult not to question whether these benefits are valid and worth striving to achieve. When you consider that persons who undergo PFA are typically in the later years of their life and have limited mobility, it raises the question of whether we place too much emphasis on achieving the purported functional benefits of PFA and too little emphasis on achieving primary wound healing and mitigating the high rates of complications and subsequent Amputation. If further research supports what we see emerging in the evidence, there will be a case to be made for selecting the level of PFA based primarily on the potential for wound healing, rather than trying to strike a balance with the perceived functional benefits. This may mean that transtibial Amputation is preferable in many cases, given the lower rates of complications and secondary Amputation, very similar function in terms of walking and energy expenditure, and similar lived experience of limb loss when compared with persons with PFA. Further research is needed to better understand the complications and benefits of PFA to make this a more viable, first-and-final Amputation procedure.

  • Influence of marker models on ankle kinematics in persons with partial Foot Amputation: an investigation using a mechanical model.
    Journal of rehabilitation research and development, 2008
    Co-Authors: Michael P Dillon, Andrew H. Hansen, Stefania Fatone
    Abstract:

    INTRODUCTION A systematic review on the biomechanics of gait in persons with partial Foot Amputation (PFA) concluded that there was a high level of evidence that PFA affects the temporospatial, external force, kinematic, kinetic, and plantar pressure aspects of PFA gait, but there was less confidence in the evidence regarding exactly how these aspects of gait were affected [1]. Dillon et al. suggested that a number of methodological problems endemic in this body of literature reduced confidence in the evidence [1]. For example, with the exception of two studies [2-3], marker placement was not explicitly described [4-6], which is problematic because marker placement defines the kinematic measurements. Since most authors reported using commercially available systems to collect these data [4-6], one can only assume that they followed the standard marker placement procedures required of those systems. However, most of the studies did not describe how certain markers were placed in the presence of a prosthesis or the absence of the foreFoot landmarks typically used to locate some of the markers defining the Foot local coordinate system. Given these sorts of methodological issues, it is not surprising that the ankle kinematic data vary markedly between investigations. Concerns have been raised regarding the accuracy of these data, especially with respect to discrepancies between bareFoot and shod/ device investigations [1]. Previous studies of bareFoot walking in PFA suggest that ankle dorsiflexion range is either reduced or similar to that observed in persons without Amputation. Garabolsa et al. observed significantly less dorsiflexion of the residuum during gait compared with the sound limb in a group of persons with dysvascular transmetatarsal (TMT) Amputation [3]. Boyd et al. investigated groups of persons with dysvascular Amputation with either toe, metatarsophalangeal (MTP), or ray Amputations, but how many toes or rays were affected in these groups was unclear [5]. No significant differences existed in ankle dorsiflexion between groups of subjects with Amputation and a control group of nondisabled subjects who walked more quickly. Unclear descriptions of Amputation level [5] make comparison between these studies difficult and walking velocity was either not reported [3] or expressed as a proportion of a laboratory normal database [5]. Hence, accounting for the influence of walking speed between investigations was not possible. Tang et al. reported bareFoot kinematics for a group of individuals with "mostly traumatic" TMT Amputation as part of an experimental study comparing gait in several conditions, including bareFoot, shoe only, or shoe plus prosthesis (insole with carbon fiber Footplate) [4]. The dorsiflexion peak observed in the control group was similar to that seen in the PFA bareFoot walking condition despite some dorsiflexion bias in the PFA group. Such bias of the kinematic data raises concerns about the modeling and changing of markers between experimental conditions. When the total ankle range from initial plantar flexion peak to dorsiflexion peak is considered, the PFA subjects walking bareFoot exhibited reduced angular excursion compared with the control group [4]. In contrast to the relatively normal or reduced ankle dorsiflexion observed during bareFoot ambulation in PFA, studies measuring ankle motion in shoe or shoe plus prosthesis conditions suggest that ankle dorsiflexion is increased. Tang et al. reported that for a group of individuals with TMT Amputation, the shoe and shoe plus prosthesis conditions allowed significantly greater ankle dorsiflexion during stance compared with walking bareFoot or a shod control group [4]. An observational study by Dillon reported a similar pattern of ankle movement in persons with Lisfranc and TMT Amputation using either toe fillers, slipper sockets, or shoes stuffed with a variety of materials, but the dorsiflexion range and peak were more normal and comparable with the 95 percent confidence interval of the control group [7]. …

Jinchuan Yan - One of the best experts on this subject based on the ideXlab platform.

David Armstrong - One of the best experts on this subject based on the ideXlab platform.

  • Accuracy of a Foot temperature monitoring mat for predicting diabetic Foot ulcers in patients with recent wounds or partial Foot Amputation.
    Diabetes research and clinical practice, 2020
    Co-Authors: Ian L. Gordon, Gary M. Rothenberg, Brian Lepow, Brian J. Petersen, David R. Linders, Jonathan D. Bloom, David Armstrong
    Abstract:

    Abstract Aims To assess the accuracy of once-daily Foot temperature monitoring for predicting Foot ulceration in diabetic patients with recent wounds and partial Foot Amputation, complications previously perceived as challenging. Methods We completed a planned analysis of existing data from a recent study in 129 participants with a previously-healed diabetic Foot ulcer. We considered four cohorts: all participants, participants with partial Foot Amputation, participants with a recent wound, and participants without partial Foot Amputation and without a recent wound. We reported the prediction specificity, lead time, and annualized alert frequency in each cohort at maximum sensitivity. We assessed the two potentially challenging cohorts for non-inferior accuracy relative to the control cohort using Delong’s method. Results We report non-inferior predictive accuracy in each of the two potentially-challenging cohorts relative to the control cohort (⍺  Conclusions Once-daily Foot temperature monitoring is no less accurate for predicting Foot ulceration in those with recent wounds and partial Foot Amputations than in those without these complications. These results support expanded practice of once-daily Foot temperature monitoring, which may result in improved patient outcomes and reduced healthcare resource utilization.

  • negative pressure wound therapy via vacuum assisted closure following partial Foot Amputation what is the role of wound chronicity
    International Wound Journal, 2007
    Co-Authors: David Armstrong, Lawrence A. Lavery, Andrew J M Boulton
    Abstract:

    Randomised clinical trials (RCTs) to evaluate diabetic Foot wound therapies have systematically eliminated large acute wounds from evaluation, focusing only on smaller chronic wounds. The purpose of this study was to evaluate the proportion and rate of wound healing in acute and chronic wounds after partial Foot Amputation in individuals with diabetes treated with negative pressure wound therapy (NPWT) delivered by the vacuum-assisted closure (VAC) device or with standard wound therapy (SWT). This study constitutes a secondary analysis of patients enrolled in a 16-week RCT of NPWT: 162 open Foot Amputation wounds (mean wound size = 20.7 cm(2)) were included. Acute wounds were defined as the wounds less than 30 days after Amputation, whereas chronic wounds as the wounds greater than 30 days. Inclusion criteria consisted of individuals older than 18 years, presence of a diabetic Foot Amputation wound up to the transmetatarsal level and adequate perfusion. Wound size and healing were confirmed by independent, blinded wound evaluators. Analyses were done on an intent-to-treat basis. There was a significantly higher proportion of acute wounds (SWT = 59; NPWT = 63) than chronic wounds (SWT = 26; NPWT = 14), evaluated in this clinical trial (P = 0.001). There was no significant difference in the proportion of acute and chronic wounds achieving complete wound closure in either treatment group. Despite this finding, the Kaplan-Meier curves demonstrated statistically significantly faster healing in the NPWT group in both acute (P = 0.030) and chronic wounds (P = 0.033). Among the patients treated with NPWT via the VAC, there was not a significant difference in healing as a function of chronicity. In both the acute and the chronic wound groups, results for patients treated with NPWT were superior to those for the patients treated with SWT. These results appear to indicate that wound duration should not deter the clinician from using this modality to treat complex wounds.

  • Negative pressure wound therapy via vacuum‐assisted closure following partial Foot Amputation: what is the role of wound chronicity?
    International wound journal, 2007
    Co-Authors: David Armstrong, Lawrence A. Lavery, Andrew J M Boulton
    Abstract:

    Randomised clinical trials (RCTs) to evaluate diabetic Foot wound therapies have systematically eliminated large acute wounds from evaluation, focusing only on smaller chronic wounds. The purpose of this study was to evaluate the proportion and rate of wound healing in acute and chronic wounds after partial Foot Amputation in individuals with diabetes treated with negative pressure wound therapy (NPWT) delivered by the vacuum-assisted closure (VAC) device or with standard wound therapy (SWT). This study constitutes a secondary analysis of patients enrolled in a 16-week RCT of NPWT: 162 open Foot Amputation wounds (mean wound size = 20.7 cm(2)) were included. Acute wounds were defined as the wounds less than 30 days after Amputation, whereas chronic wounds as the wounds greater than 30 days. Inclusion criteria consisted of individuals older than 18 years, presence of a diabetic Foot Amputation wound up to the transmetatarsal level and adequate perfusion. Wound size and healing were confirmed by independent, blinded wound evaluators. Analyses were done on an intent-to-treat basis. There was a significantly higher proportion of acute wounds (SWT = 59; NPWT = 63) than chronic wounds (SWT = 26; NPWT = 14), evaluated in this clinical trial (P = 0.001). There was no significant difference in the proportion of acute and chronic wounds achieving complete wound closure in either treatment group. Despite this finding, the Kaplan-Meier curves demonstrated statistically significantly faster healing in the NPWT group in both acute (P = 0.030) and chronic wounds (P = 0.033). Among the patients treated with NPWT via the VAC, there was not a significant difference in healing as a function of chronicity. In both the acute and the chronic wound groups, results for patients treated with NPWT were superior to those for the patients treated with SWT. These results appear to indicate that wound duration should not deter the clinician from using this modality to treat complex wounds.

  • negative pressure wound therapy after partial diabetic Foot Amputation a multicentre randomised controlled trial
    The Lancet, 2005
    Co-Authors: David Armstrong, Lawrence A. Lavery
    Abstract:

    Methods We enrolled 162 patients into a 16-week, 18-centre, randomised clinical trial in the USA. Inclusion criteria consisted of partial Foot Amputation wounds up to the transmetatarsal level and evidence of adequate perfusion. Patients who were randomly assigned to NPWT (n=77) received treatment with dressing changes every 48 h. Control patients (n=85) received standard moist wound care according to consensus guidelines. NPWT was delivered through the Vacuum Assisted Closure (VAC) Therapy System. Wounds were treated until healing or completion of the 112-day period of active treatment. Analysis was by intention to treat. This study has been registered with ClinicalTrials.gov, number NCT00224796. Findings More patients healed in the NPWT group than in the control group (43 (56%) vs 33 (39%), p=0·040). The rate of wound healing, based on the time to complete closure, was faster in the NPWT group than in controls (p=0·005). The rate of granulation tissue formation, based on the time to 76-100% formation in the wound bed, was faster in the NPWT group than in controls (p=0·002). The frequency and severity of adverse events (of which the most common was wound infection) were similar in both treatment groups.

  • Plantar pressures are higher in diabetic patients following partial Foot Amputation.
    Ostomy wound management, 1998
    Co-Authors: David Armstrong, Lawrence A. Lavery
    Abstract:

    The purpose of this study was to compare peak plantar pressure in diabetic patients with and without Foot-level Amputation. This project was conducted as a case-control study. We enrolled 27 cases and 150 controls diagnosed with diabetes mellitus. Cases were defined as patients with a history of foreFoot-level Amputation (digit or ray Amputations distal to the tarsometatarsal joint) secondary to an infected foreFoot wound. Controls were defined as subjects that had never had a Foot ulceration. We used a pressure platform system to evaluate dynamic bareFoot pressure on the sole of the Foot. There was no significant difference in vascular perfusion or body mass index between the case and control groups. Patients with a Foot-level Amputation were nearly ten times more likely to present with limited joint mobility or a rigid Foot deformity than those without Amputation (92.6% vs. 44.0%, p < 0.0001, X2 = 13.0, Odds Ratio = 9.8 CI = 2.2 to 43.0). Peak plantar pressure was significantly higher for patients with Amputations compared to controls (80.0 +/- 31.1 N/cm2, vs, 62.5 +/- 21.0 N/cm2, p < 0.001). Peak pressure and limited joint mobility have long been associated with ulceration. We conclude that increased pressure and contractures associated with biomechanical compensation following a partial Foot Amputation further increase plantar pressure, placing an already high-risk limb at further risk for tissue breakdown and reAmputation.

Zhongqun Wang - One of the best experts on this subject based on the ideXlab platform.