Patients with diabetes mellitus have a lifetime risk of 15% to 25% of developing diabetic foot ulcers (DFUs). DFU is associated with significant morbidity and mortality. Wound imaging systems are useful adjuncts in monitoring of wound progress. Our study aims to review existing literature on the available wound assessment and monitoring systems for DFU. This is a systematic review of articles from PubMed and Embase (1974 – March 2020). All studies related to wound assessment or monitoring systems in DFUs were included. Articles on other types of wounds, review articles, and non-English texts were excluded. Outcomes include clinical use, wound measurement statistics, hospital system integration, and other advantages and challenges. The search identified 531 articles. Seventeen full-text studies were eligible for the final analysis. Five modalities were identified: (a) computer applications or hand-held devices (n = 5), (b) mobile applications (n = 2), (c) optical imaging (n = 2), (d) spectroscopy or hyperspectral imaging (n = 4), and (e) artificial intelligence (n = 4). Most studies (n = 16) reported on wound assessment or monitoring. Only one study reported on data capturing. Two studies on the use of computer applications reported low inter-observer variability in wound measurement (inter-rater reliability >0.99, and inter-observer variability 15.9% respectively). Hand-held commercial devices demonstrated high accuracy (relative error of 2.1%-6.8%). Use of spectroscopy or hyperspectral imaging in prediction of wound healing has a sensitivity and specificity of 80% to 90% and 74%to 86%, respectively. Majority of the commercially available wound assessment systems have not been reviewed in the literature on measurement accuracy. In conclusion, most imaging systems are superior to traditional wound assessment. Wound imaging systems should be used as adjuncts in DFU monitoring.
Keywords: artificial intelligence; diabetic foot; mobile applications; wound healing; wounds and injuries.
[Tratto da: pubmed.ncbi.nlm.nih.gov ]
The widespread use of mobile technologies can potentially expand the use of telemedicine approaches to facilitate communication between healthcare providers, this might increase access to specialist advice and improve patient health outcomes.
To assess the effects of mobile technologies versus usual care for supporting communication and consultations between healthcare providers on healthcare providers’ performance, acceptability and satisfaction, healthcare use, patient health outcomes, acceptability and satisfaction, costs, and technical difficulties.
We searched CENTRAL, MEDLINE, Embase and three other databases from 1 January 2000 to 22 July 2019. We searched clinical trials registries, checked references of relevant systematic reviews and included studies, and contacted topic experts.
Randomised trials comparing mobile technologies to support healthcare provider to healthcare provider communication and consultations compared with usual care.
Data collection and analysis
We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence.
We included 19 trials (5766 participants when reported), most were conducted in high‐income countries. The most frequently used mobile technology was a mobile phone, often accompanied by training if it was used to transfer digital images. Trials recruited participants with different conditions, and interventions varied in delivery, components, and frequency of contact. We judged most trials to have high risk of performance bias, and approximately half had a high risk of detection, attrition, and reporting biases. Two studies reported data on technical problems, reporting few difficulties.
Mobile technologies used by primary care providers to consult with hospital specialists
We assessed the certainty of evidence for this group of trials as moderate to low.
‐ probably make little or no difference to primary care providers following guidelines for people with chronic kidney disease (CKD; 1 trial, 47 general practices, 3004 participants);
‐ probably reduce the time between presentation and management of individuals with skin conditions, people with symptoms requiring an ultrasound, or being referred for an appointment with a specialist after attending primary care (4 trials, 656 participants);
‐ may reduce referrals and clinic visits among people with some skin conditions, and increase the likelihood of receiving retinopathy screening among people with diabetes, or an ultrasound in those referred with symptoms (9 trials, 4810 participants when reported);
‐ probably make little or no difference to patient‐reported quality of life and health‐related quality of life (2 trials, 622 participants) or to clinician‐assessed clinical recovery (2 trials, 769 participants) among individuals with skin conditions;
‐ may make little or no difference to healthcare provider (2 trials, 378 participants) or participant acceptability and satisfaction (4 trials, 972 participants) when primary care providers consult with dermatologists;
‐ may make little or no difference for total or expected costs per participant for adults with some skin conditions or CKD (6 trials, 5423 participants).
Mobile technologies used by emergency physicians to consult with hospital specialists about people attending the emergency department
We assessed the certainty of evidence for this group of trials as moderate.
‐ probably slightly reduce the consultation time between emergency physicians and hospital specialists (median difference −12 minutes, 95% CI −19 to −7; 1 trial, 345 participants);
‐ probably reduce participants’ length of stay in the emergency department by a few minutes (median difference −30 minutes, 95% CI −37 to −25; 1 trial, 345 participants).
We did not identify trials that reported on providers’ adherence, participants’ health status and well‐being, healthcare provider and participant acceptability and satisfaction, or costs.
Mobile technologies used by community health workers or home‐care workers to consult with clinic staff
We assessed the certainty of evidence for this group of trials as moderate to low.
‐ probably make little or no difference in the number of outpatient clinic and community nurse consultations for participants with diabetes or older individuals treated with home enteral nutrition (2 trials, 370 participants) or hospitalisation of older individuals treated with home enteral nutrition (1 trial, 188 participants);
‐ may lead to little or no difference in mortality among people living with HIV (RR 0.82, 95% CI 0.55 to 1.22) or diabetes (RR 0.94, 95% CI 0.28 to 3.12) (2 trials, 1152 participants);
‐ may make little or no difference to participants’ disease activity or health‐related quality of life in participants with rheumatoid arthritis (1 trial, 85 participants);
‐ probably make little or no difference for participant acceptability and satisfaction for participants with diabetes and participants with rheumatoid arthritis (2 trials, 178 participants).
We did not identify any trials that reported on providers’ adherence, time between presentation and management, healthcare provider acceptability and satisfaction, or costs.
Our confidence in the effect estimates is limited. Interventions including a mobile technology component to support healthcare provider to healthcare provider communication and management of care may reduce the time between presentation and management of the health condition when primary care providers or emergency physicians use them to consult with specialists, and may increase the likelihood of receiving a clinical examination among participants with diabetes and those who required an ultrasound. They may decrease the number of people attending primary care who are referred to secondary or tertiary care in some conditions, such as some skin conditions and CKD. There was little evidence of effects on participants’ health status and well‐being, satisfaction, or costs.
[Tratto da: www.cochranelibrary.com ]
Ebbene sì, siete in 100.000!
Ormai non ci sono parole per ringraziarvi per il supporto e per tutti gli attestati di stima che quotidianamente ci riservate.
Non ci rimane che percorrere questa strada iniziata nel Novembre 2017 (420 articoli ad oggi), con il solito entusiasmo e con qualche novità…
…Grazie lo STAFF
Dal 1° Settembre, è terminata la mia collaborazione professionale, con l’ AMBULATORIO INFERMIERISTICO VULNOLOGICO di Bergamo Sanità.
Un progetto nato in sordina, circa tre anni fa, in accordo con il Presidente dell’ Azienda sopracitata, in un territorio difficile, ma che sin da subito ha apportato: innovazione, qualità assistenziale e intervento multidisciplinare all’ avanguardia.
In regime privato ma a prezzi calmierati visto l’ indigenza dilagante, toccando e scoprendo un argomento ancor oggi sconosciuto a molti, subdolo, silente come le lesioni cutanee.
Ringrazio tutti indistintamente e auguro un futuro florido a questo importantissimo progetto, che perde un collaboratore- referente, ma non l’ importanza sociale per cui nacque.
Terminato l’ iter burocratico di legge, finalmente il progetto LESIONI TOUR è un marchio registrato.
Le Lesioni Da Pressione, sono un problema ancora sconosciuto a molti e la mancanza di sensibilizzazione della popolazione su questo argomento è la principale motivazione di disorientamento di familiari/caregiver, che una volta colpiti, si troveranno ad affrontare la situazione brancolando nel buio con il rischio di commettere errori talvolta fatali.
Il progetto “Lesioni Tour” è nato a fine 2017 dopo un attento studio degli indicatori (natalità-decessi-età media) e qualità di vita della provincia bergamasca paragonati a quelli del territorio italiano e che si pone l’obiettivo di supportare chi si è trovato a convivere con una problematica così seria e si è sentito abbandonato, mira a tradurre in maniera semplice un argomento complesso come quello delle lesioni cutanee, verranno realizzati dei piccoli spot che conterranno consigli per evitare laddove possibile l’errore e fornire le armi per scegliere la strada migliore per il proprio caro.
Perchè il caregiver è elemento fondamentale per la prevenzione delle lesioni cutanee.
Per l’emergenza COVID19 gli incontri, salvo ulteriori imprevisti riprenderanno nel 2021 con ulteriori novità.
Nel frattempo ringrazio chi ha creduto sin da subito nel progetto.
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