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DIABETIC FOOT SURGERY ‘‘MADE IN ITALY”. RESULTS OF 15 YEARS OF ACTIVITY OF A THIRD-LEVEL CENTRE MANAGED BY DIABETOLOGISTS

Terrific valedictory work by our long-time SALSAmigo, Prof. Alberto Piaggesi, et al from Pisa.

Aim: To evaluate clinical outcomes in patients who underwent diabetic foot surgery (DFS) managed directly by diabetologists in a third-level Centre over 15-year.
Methods: We retrospectively evaluated 1.857 patients affected by diabetic foot (Age 67.1 ± 12.3 yrs, diabetes duration 19.2 ± 9.8 yrs, HbA1c 8.1 ± 2.0%) treated in our Department between 2001 and 2015 and divided them into 3 groups: Group 1, treated between 2001 and 2005 (448 pts), group 2, between 2006 and 2010 (540 pts) and Group 3, between 2011 and 2015 (869 pts). Main clinical outcomes [peripheral revascularization rate (PR), healing rate (HR), healing time (HT), recurrences after healing (R), major amputation (MA) and death (D) rates] were compared between groups.

Results: The overall outcomes of our cohort were: HR 81.6% (HT 143 ± 54 days), PR 84.8%, MA 4.9% and D 27.9%. There were no differences in clinical characteristics, except for age, higher (p < 0.05) in Group 3 (70.6 ± 14.7 yrs) than in Groups 1 (64.4 ± 11.6 yrs) and 2 (65.1 ± 11.2 yrs). No differences emerged when comparing HR and MA; HT was shorter (p < 0.05) in group 3 (104 ± 44 days) than in Group 2 (169 ± 72 days) and 1 (235 ± 67 days). D was higher (p < 0.05) in Group 3 (43.8%) than in Group 1 (23.1%) and 2 (28.1%). PR was 19.4% in Group 1, 28.1% in Group 2 and 53.8% in Group 3 (p < 0.05).

Conclusions: Despite the increasing age and complexity of patients our data show improve- ment of outcomes throughout 15 years, probably due to better surgical techniques, more aggressive medical therapy and more effective treatment of critical limb ischemia.

[ Tratto da: www.diabeticfootonline.com ]

 

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COViD-19: l’utilità delle mascherine (anche di cotone)

Con il coronavirus SARS-CoV-2 ancora attivo e in grado di circolare tra la popolazione, indossare una mascherina è comunque una buona idea: indipendentemente da obblighi e decreti, e anche se si scelgono quelle in cotone, che siano acquistate o autoprodotte. La conferma arriva da uno studio di fisica dei fluidi condotto in Florida, uno degli Stati americani al momento più colpiti dalla covid, con un numero di casi di nuovo in crescita esponenziale. Gli scienziati hanno simulato l’emissione di droplets, le goccioline di saliva che disperdiamo nell’aria in misura maggiore quando tossiamo e starnutiamo e nelle quali possono annidarsi le particelle virali, dalla bocca di un manichino. E hanno scoperto che le mascherine – incluse quelle non mediche – sono in grado di accorciare notevolmente le distanze a cui queste goccioline si spingono.

COViD-19, contagi abbattuti da distanze e mascherine

MASCHERINE A CONFRONTO. I ricercatori della Florida Atlantic University hanno collegato la testa del fantoccio a una macchina nebulizzatrice, e hanno usato una pompa per far espellere un mix di acqua distillata e glicerina (la “saliva infetta”) dalla bocca. Sotto alla luce laser, i finti starnuti sono apparsi come nuvole di vapore verde che si diffondevano nello spazio. A questo punto, il team ha sistemato davanti alla bocca e al naso del manichino diversi dispositivi di protezione non chirurgici: un fazzoletto di cotone ripiegato, una bandana monostrato, una mascherina di cotone a due strati fatta in casa usando un tessuto spesso in cotone, e una mascherina a conchiglia non sterile di quelle vendute in farmacia.

 

PROTEZIONE RECIPROCA. Senza mascherina, le regole non sempre rispettate di distanziamento fisico valgono poco, perché i droplets – dimostra l’esperimento – viaggiano fino a 3,7 metri dalla bocca. Tuttavia le mascherine hanno accorciato questo viaggio in modo netto: quando il manichino indossava quella di cotone, i droplets sono arrivati ad appena un cm di distanza dal viso, nonostante qualche “perdita” fisiologica di goccioline nei punti in cui il tessuto aderiva peggio. Anche le maschere a conchiglia hanno funzionato bene, riducendo la gittata dei droplets ad appena 20 cm dal volto. Come prevedibile, la bandana monostrato e il fazzoletto non sono stati altrettanto efficaci. Il loro utilizzo ha comunque permesso alle finte particelle virali di arrivare a un metro e a 30 cm di distanza dalla bocca rispettivamente.

 

L’esperimento, che vedete sintetizzato nel video qui sotto, dimostra – scrivono i ricercatori – «che anche se le mascherine non mediche testate consentono comunque vari livelli di dispersione dei fluidi, sono comunque probabilmente efficaci nell’ostacolare la dispersione dei droplets respiratori più grandi».

[Tratto da: www.focus.it ]

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Hydrosurgical debridement versus conventional surgical debridement for acute partial‐thickness burns

Burn injuries are the fourth most common traumatic injury, causing an estimated 180,000 deaths annually worldwide. Superficial burns can be managed with dressings alone, but deeper burns or those that fail to heal promptly are usually treated surgically. Acute burns surgery aims to debride burnt skin until healthy tissue is reached, at which point skin grafts or temporising dressings are applied. Conventional debridement is performed with an angled blade, tangentially shaving burned tissue until healthy tissue is encountered. Hydrosurgery, an alternative to conventional blade debridement, simultaneously debrides, irrigates, and removes tissue with the aim of minimising damage to uninjured tissue. Despite the increasing use of hydrosurgery, its efficacy and the risk of adverse events following surgery for burns is unclear.

Objectives

To assess the effects of hydrosurgical debridement and skin grafting versus conventional surgical debridement and skin grafting for the treatment of acute partial‐thickness burns.

Search methods

In December 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In‐Process & Other Non‐Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta‐analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.

Selection criteria

We included randomised controlled trials (RCTs) that enrolled people of any age with acute partial‐thickness burn injury and assessed the use of hydrosurgery.

Data collection and analysis

Two review authors independently performed study selection, data extraction, ‘Risk of bias’ assessment, and GRADE assessment of the certainty of the evidence.

Main results

One RCT met the inclusion criteria of this review. The study sample size was 61 paediatric participants with acute partial‐thickness burns of 3% to 4% total burn surface area. Participants were randomised to hydrosurgery or conventional debridement. There may be little or no difference in mean time to complete healing (mean difference (MD) 0.00 days, 95% confidence interval (CI) −6.25 to 6.25) or postoperative infection risk (risk ratio 1.33, 95% CI 0.57 to 3.11). These results are based on very low‐certainty evidence, which was downgraded twice for risk of bias, once for indirectness, and once for imprecision.

There may be little or no difference in operative time between hydrosurgery and conventional debridement (MD 0.2 minutes, 95% CI −12.2 to 12.6); again, the certainty of the evidence is very low, downgraded once for risk of bias, once for indirectness, and once for imprecision. There may be little or no difference in scar outcomes at six months. Health‐related quality of life, resource use, and other adverse outcomes were not reported.

Authors’ conclusions

This review contains one randomised trial of hydrosurgery versus conventional debridement in a paediatric population with low percentage of total body surface area burn injuries. Based on the available trial data, there may be little or no difference between hydrosurgery and conventional debridement in terms of time to complete healing, postoperative infection, operative time, and scar outcomes at six months. These results are based on very low‐certainty evidence. Further research evaluating these outcomes as well as health‐related quality of life, resource use, and other adverse event outcomes is required.

Plain language summary

Available in

Is surgery with a high‐pressure water jet (hydrosurgery) better than conventional surgery for early treatment of mid‐depth burns?

Background

Burns are common injuries worldwide and can cause illness, lifelong disability and even death. Deep burns often require surgery because the skin is too damaged to heal on its own. The damaged, burnt skin must therefore be cut away (debridement) and replaced with healthy skin, which is typically a very thin layer of healthy skin (graft) taken from another part of the body. Debridement is normally done with a specific surgical knife.

Recently, a high‐pressure, water‐based jet system has been developed, known as hydrosurgery. This tool removes burnt skin only, leaving behind the unburned, healthy skin. Hydrosurgery may be more accurate than a knife in terms of removing burned skin, which may lead to better healing.

All open wounds, including burns, are at risk of infection so adequate debridement is important to reduce the risk of infection. If the wound is closed quickly, it will heal better, with less scarring and less risk of infection.

What did we want to find out?

In this Cochrane Review, we wanted to know whether burns treated with hydrosurgery heal more quickly and with fewer infections than burns treated with a knife. We also wanted to see whether there were any differences in overall quality of life, how well the wound healed in terms of scarring and the amount of medical resources used (using measures like the number of dressing changes and burn clinic appointments, length of hospital stay, and whether further surgery was needed).

Our methods

We searched medical databases for randomised controlled trials that compared burn treatment using hydrosurgery with conventional debridement. Randomised controlled trials are medical studies where the treatment people receive is chosen at random. This type of study provides the most reliable evidence about whether different approaches to health care make a difference. Participants in the studies could be any age. The studies could have taken place anywhere and be reported in any language.

What are the main results of the review?

We found only one Australian study that included 61 children with small burns. The children were randomly allocated to treatment with either hydrosurgery or conventional debridement. Hydrosurgery made little or no difference in the time burns took to heal completely, infection after the operation, or scarring compared to conventional debridement. There was little or no difference in the length of time debridement took using hydrosurgery compared with conventional surgery. The study did not give any information about quality of life or resource use.

Certainty of the evidence

Our certainty (confidence) in the evidence was very limited because we found only one study. It only included children, so the results may not apply to adults or people with more severe burns. It was a randomised study, but did not report the outcomes we expected it to, so we are not sure how reliable its results are.

Conclusions

We do not know if hydrosurgery is better than conventional surgery for early treatment of mid‐depth burns. We need more studies to investigate this question.

[Tratto da: www.cochranelibrary.com ]

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Il Tour riprende…

Sabato 31/10/2020 ore 10 presso la Sala Consiliare di Piazza G.Marconi 1

Torre Boldone (BG), si terrà la nuova tappa del Lesioni TOUR ®️ .

Ringrazio il Sindaco Dott. L. Macario e l’ Assessore ai Servizi Sociali Avv. V. Bonaiti, il Sig. D. Baù di Videostar canale 90 dtv, l’ Associazione Attilio&Maria ODV e ACN sezione Wound Care per il supporto.

L’ incontro si svolgerà attenendosi a tutte le norme vigenti anti-COVID19, inoltre gli ingressi saranno nominali (massimo 25 partecipanti), pertanto è gradita l’ iscrizione attraverso la mail:

lesionitour@gmail.com

Ingresso GRATUITO, NO CREDITI ECM , rivolto a: badanti, caregiver, familiari, OSS, Infermieri e/o professionisti sanitari che si occupano o stanno muovendo i primi passi in materia di cura delle ferite.

Perchè parlare di WOUND CARE, si può? NO, si DEVE!

 

Pubblicato il

Lesioni TOUR ®️ 20-20

 Un percorso iniziato bussando mille porte, ricevendo risposte (per chi ha avuto la decenza di rispondere) in talune occasioni non ripetibili per non dire assurde (!), ma che ha riscosso un successo insperato, fino a giungere ai giorni nostri, un marchio registrato e tanta voglia ( pandemie permettendo) di continuare un percorso a favore del malato fragile e del suo familiare lasciato sempre più solo in un territorio devastato dagli ultimi accadimenti e non solo.
Ringrazio i partecipanti, la mia testa dura e la mia famiglia.
STAY TUNED!
Per informazioni:
lesionitour@gmail.com
Pubblicato il

Wound assessment, imaging and monitoring systems in diabetic foot ulcers: A systematic review

Abstract

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 ]

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Mobile technologies to support healthcare provider to healthcare provider communication and management of care

Background

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.

Objectives

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.

Search methods

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.

Selection criteria

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.

Main results

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.

Mobile technologies:

‐ 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.

Mobile technologies:

‐ 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.

Mobile technologies:

‐ 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.

Authors’ conclusions

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 ]

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Grazie 100.000!

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

 

Pubblicato il

Ambulatorio Vulnologico Infermieristico

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.

Grazie IS.