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The Validity And Reliability Of Remote Diabetic Foot Ulcer Assessment Using Mobile Phone Images

The Validity And Reliability Of Remote Diabetic Foot Ulcer Assessment Using Mobile Phone Images

The validity and reliability of remote diabetic foot ulcer assessment using mobile phone images Scientific Reportsvolume7, Articlenumber:9480 (2017) Despite their potential for telemedicine in diabetic foot ulcer treatment, diagnostic accuracy of assessment of diabetic foot ulcers using mobile phone images is unknown. Our aim was to determine the validity and reliability of remote diabetic foot ulcer assessment using mobile phone images. Fifty diabetic foot ulcers were assessed live and photographed. Five independent observers remotely assessed the mobile phone images twice for presence of nine clinical characteristics and three treatment decisions. Positive likelihood (LLR+) and negative likelihood (LLR) ratios were calculated for validity. Multirater Randolphs and bi-rater Bennet kappa values were calculated for reliability. LLR+ ranged from 1.34.2; LLR ranged from 0.130.88; the treatment decision peri-wound debridement was the only item with strong diagnostic evidence. Inter-observer reliability kappa ranged from 0.090.71; test-retest reliability from 0.450.86; the treatment decision peri-wound debridement was the only item with adequate agreement. In conclusion, mobile phone images had low validity and reliability for remote assessment of diabetic foot ulcers and should not be used as a stand-alone diagnostic instrument. Clinicians who use mobile phone images in clinical practice should obtain as much additional information as possible when making treatment decisions based on these images, and be cautious of the low diagnostic accuracy. Diabetic foot ulcers are a major health problem with significant morbidity and mortality 1 , 2 . Recent global pooled estimates indicate 3.4% of all inpatients have a diabetic foot ulcer, and 1.5% a diabetes-related amputation proce Continue reading >>

Model Of Care For The

Model Of Care For The

Diabetic Foot National Diabetes Programme Clinical Strategy and Programmes Directorate 2011 Document Control Revision number: 01 Document drafted by: National Diabetes Programme Working Group Approval date: October 2011 Document approved by: National Diabetes Programme, Clinical Advisory Group of the HSE/RCPI Primary care and local hospitals delivering care for the diabetic foot Responsibility for evaluation and audit: National Diabetes Programme National Diabetes Programme, Clinical Strategy and Programmes Directorate i Contents 1.0 Introduction 1 1.1 Purpose of the Model of Care 1 1.2 Overview 2 1.3 Multidisciplinary Team Member Involvement 3 1.4 Integrated Model of Management/Care Pathway for People with Diabetic Foot Problems 3 2.0 Diabetes Foot Screening 4 2.1 Routine Foot Screening Process 4 3.0 Low Risk Foot (Green) 5 3.1 Foot Examination Frequency 5 3.2 Examiner 5 3.3 Screening of the Low Risk Foot 5 3.4 Management 5 4.0 At Risk Foot [Moderate Risk (Amber), High Risk (Pink)] 6 4.1 Moderate Risk Foot (Amber) 6 4.1.1 Foot Examination Frequency 6 4.1.2 Examiners 6 4.1.3 Examination 6 4.1.4 Management 6 4.1.5 Clinical Governance 7 4.2 High Risk Foot (Pink) 7 4.2.1 Foot Examination Frequency 7 4.2.2 Examiners 7 4.2.3 Examination 7 4.2.4 Management 8 4.2.5 Clinical Governance 8 5.0 Active Foot Disease (Red) 9 5.1 Referral 9 5.2 Foot Examination Frequency 9 5.3 Examiners 9 5.4 Examination 9 5.5 Management 9 5.6 Clinical Governance 10 Appendix 1 Integrated Model of Management/Care Pathway for People with Diabetic Foot Problems 12 Appendix 2 Diabetes Foot Screening Instructions 13 Appendix 3 Diabetes Foot Screening Tool 15 Appendix 4 Referral to Foot Protection Service 16 Appendix 5 Diabetes Peripheral Vascular Assessment Form 17 Appendix 6 Diabetes Foot Ulcer Assessment Continue reading >>

Diabetic Foot Care Services In Syracuse, Ny

Diabetic Foot Care Services In Syracuse, Ny

SOS’ podiatrists treat a variety of foot conditions and other common podiatry ailments. Foot problems most often happen when there is nerve damage, also called neuropathy. Neuropathy can cause tingling, pain, or weakness in the foot. It can also cause loss of feeling in the foot, so you can injure it and not know it. Poor blood flow or changes in the shape of your feet or toes may also cause problems. The SOS Podiatry team is comprised of experienced foot doctors serving Syracuse, NY and the surrounding areas. The SOS Podiatry team includes Dr. Stephanie Hook, a board certified podiatrist trained in all types of podiatric medicine and surgery including rheumatologic conditions, pediatric podiatry, and diabetic foot care; and Dr. Christopher J. Fatti. Dr. Christopher Fatti has extensive training in diabetic foot & ulcer care and limb salvage techniques. He also specializes in elective foot surgery including bunion, hammertoes and other toe deformities, flatfoot deformity, heel pain, sports injuries, fracture care, and many other common foot ailments. What is Diabetic Foot Care? Diabetes affects the body’s ability to produce or respond to the hormone insulin. The nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy (which occurs in about 70 percent of people with diabetes). Diabetes can cause changes in the skin of your foot - at times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your foot no longer work. We depend on our feet to keep us moving. But when you have diabetes, your feet need special care - even a small foot problem can become very serious. So don’t take your feet for granted. By working with SOS’s Podiatry Sp Continue reading >>

Diabetic Foot Assessment

Diabetic Foot Assessment

This is conducted chiefly to help quickly identify patients at high risk of developing complications as a result of diabetes. General social and medical history are considered first. This is followed by a vascular assessment involving pulse palpation, visual check and activity proficiency; vital to evaluate possible signs of critical ischaemia. Neurological assessment comprising touch sensation and motor output testing evaluate likelihood of future ulceration. Feet and footwear are contemplated as foot shape and compatibility with shoes is essential in prevention of complications. From these tests the patient can be placed in a risk category which indicates possible referral pathways. Prevention is better than cure in these cases. Early identification of skin changes is essential, requiring patient education to recognise and avoid high risk scenarios. Existing ulcers can be protected and off-loaded with padding, orthoses, soft boots or if necessary bed rest. Debridement of the wound may be necessary to create better conditions for healing. Multidisciplinary team involvement may be necessary in order that your wound is re-dressed often enough. Treatment of peripheral neuropathy & poor circulation Treatment is based around prevention of signs and symptoms. This is achieved through blood glucose level control in the form of drug administration and nutritional advice. The podiatrist conducts a full diabetic foot assessment to gauge vascular, neurological and tissue status. Complications of diabetes are treated as they occur and in conjunction with blood glucose control. Footwear and orthotics play an important role in diabetic foot care to provide comfort and the following protective benefits: High, wide toe box (high and wide space in the toe area) Removable insoles for f Continue reading >>

Diabetic Foot | The Bmj

Diabetic Foot | The Bmj

Satish Chandra Mishra, consultant surgeon and scientist 1 , 1Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India 3Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India 4Global Health and Development Group, Imperial College London, St Marys Hospital, London, UK Correspondence to: A Mehndiratta abha{at}mail.harvard.edu Diabetic foot can be prevented with good glycaemic control, regular foot assessment, appropriate footwear, patient education, and early referral for pre-ulcerative lesions Examine the feet of people with diabetes for any lesions and screen for peripheral neuropathy and peripheral arterial disease, which can lead to injuries or ulceration Refer patients with foot ulceration and signs of infection, sepsis, or ischaemia immediately to a specialised diabetic foot centre for surgical care, revascularisation, and rehabilitation Foot disease affects nearly 6% of people with diabetes 1 and includes infection, ulceration, or destruction of tissues of the foot. 2 It can impair patients quality of life and affect social participation and livelihood. 3 Between 0.03% and 1.5% of patients with diabetic foot require an amputation. 4 Most amputations start with ulcers and can be prevented with good foot care and screening to assess the risk for foot complications. 5 We provide an update on the prevention and initial management of diabetic foot in primary care. This clinical update is based on recommendations in the standard treatment guideline, The diabetic foot: prevention and management in India 2016, published by the Indian Ministry of Health and Family Welfare. 33 A multidisciplinary guideline development group consisting of surgeons, primary care practitioners, and a patient representative developed these Continue reading >>

Podiatric Assessment And Management Of The Diabetic Foot

Podiatric Assessment And Management Of The Diabetic Foot

Podiatric Assessment and Management of the Diabetic Foot Podiatric Assessment and Management of the Diabetic Foot Personal information is secured with SSL technology. Packed with practical tips and advice for the podiatrist, this unique book gives students, practitioners and other healthcare professionals working with the diabetic foot fresh insights into the role of the podiatrist in diabetic foot care and the many ways in which outcomes for diabetic foot patients can be improved. Using a very practical approach with case histories and clinical tips, it describes how podiatrists can accurately assess and efficiently manage the diabetic foot, and looks at how podiatric care should be adapted according to the type and stage of foot being dealt with. Detailed management programmes geared to all types of patient from low risk to high risk, clear guidance on when to seek the advice of other members of the multidisciplinary team, and special consideration of the podiatric management of particularly challenging sub-groups of diabetic patients are just some of the areas covered in this handy volume. The rationales behind all podiatric treatments for diabetic feet are clearly discussed, along with detailed descriptions of techniques and procedures, many of which have not previously been written about in podiatry books. With full colour throughout and many invaluable photographs from the author's own collection, Podiatric Assessment and Management of the Diabetic Foot is written specially for podiatrists by a podiatrist, but will be also be an essential purchase for all healthcare professionals involved in the field of diabetic foot care. Unique in being written specifically with podiatrists in mind. Liberally illustrated with full-colour photographs. Practically orientated for Continue reading >>

Is My Test, Item, Or Service Covered?

Is My Test, Item, Or Service Covered?

How often is it covered? Medicare Part B (Medical Insurance) covers a foot exam every 6 months as long as you haven't seen a foot care professional for another reason between visits. Who's eligible? All people with Part B who have diabetes, diabetic peripheral neuropathy, and loss of protective sensations are covered. Your costs in Original Medicare To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like: Other insurance you may have How much your doctor charges Whether your doctor accepts assignment The type of facility The location where you get your test, item, or service Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them. Continue reading >>

How To Complete Diabetic Shoe Medicare Forms Correctly

How To Complete Diabetic Shoe Medicare Forms Correctly

Issue Number: Volume 29 - Issue 11 - November 2016 This author guides podiatrists through compliance paperwork for diabetic shoes that can help ensure payment for diabetic shoes. The purpose of this article is to provide the recipe to create a documentation packet that will pass a Diabetic Shoe Pre-Payment Review. If you have ever seen Chopped on the Food Network, chefs compete for $10,000 as they try to make stellar dishes using surprise ingredients. Thankfully, the Diabetic Shoe Compliance paperwork is nothing like Chopped. The required documents are clearly defined beforehand without any surprise ingredients. Read the ingredients and follow the directions. Since the “freshness” of the ingredients is important, the lifespan of each document is included. Although there are nine ingredients, the recipe is simple. 1. Detailed written order (prescription). Include space for prescribing shoes (A5500), the quantity of custom inserts (A5513) or quantity of prefab heat-moldable inserts (A5512). This must be dated within six months of dispensing shoes. 2. Statement of certification. Include space for asking the date of the last diabetic exam. The Statement of Certification must be dated within three months of dispensing shoes. (For the last diabetic exam, see item 3 below.) 3. Diabetes management exam. This is the diabetic exam progress note from the MD managing the patient’s diabetes. I recommend asking the MD only for the date of this exam. If the progress note is needed later for a pre-payment review, one can easily obtain the exam note. In my opinion, your referring MDs may object to copying their notes for every patient with diabetes. Giving you the date of the exam is much less time-consuming for the MD’s office. This must be an exam within six months of dispensi Continue reading >>

Diabetic Assessment Fitfeet Podiatry

Diabetic Assessment Fitfeet Podiatry

Are you diabetic? Dont be a statistic and risk losing a foot or a leg! Let us check your feet and show you how to prevent problems occurring. Diabetes disrupts the vascular system affecting many areas of the body, such as eyes, kidneys, legs and feet. This can result in poor circulation and nerve damage. As a Diabetic (Type 1 and Type 2) you are encouraged to have your feet checked annually. Patients who suffer from Diabetes and other chronic conditions that can affect the feet can receive a care plan which will allow you to have up to 5 visits per calendar year paid by medicare. See your GP for details. Caring for your feet is very important as long term problems with your feet and legs could eventually lead to amputation. Inspect your feet daily, after your shower as you dry your feet is a good opportunity. Look for any redness, swelling, blisters, corns, calluses or cuts. If you have difficulty reaching your feet, use a mirror or have someone look at them for you. If you find a problem, see your doctor or podiatrist as soon as possible. This greatly reduces the risk of damage to the feet that can lead to amputation. Diabetes is the fastest growing condition in Australia. It is estimated that there are currently 1.7 million Australians living with diabetes, yet only 1.1 million of these people know that they have diabetes. Diabetes has overtaken heart disease as the leading cause of the disease burden in Australia. On average, 28 people are diagnosed every day in WA; more than 1 every hour. There are currently more than 120,000 people living with some form of diabetes in WA. Of these: Continue reading >>

Frequently Asked Questions: Diabetic Foot Ulcers

Frequently Asked Questions: Diabetic Foot Ulcers

Frequently Asked Questions: Diabetic Foot Ulcers Frequently Asked Questions: Diabetic Foot Ulcers A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes, and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication. Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable. Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers. Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, footdeformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack ofability to feel painin the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament. Vascular disease can complicate a foot ulcer, reducing the bodys ability to heal and increasing the risk for an infection. Elevations in bl Continue reading >>

Contributions Of Dr. Sweta Tewary (gec)

Contributions Of Dr. Sweta Tewary (gec)

DIABETES FOOT EDUCATION; AN EVIDENCE-BASED APPROACH IN LONG-TERM CARE Naushira Pandya, MD, CMD Professor and Chair Director, Geriatrics Education Center Nova Southeastern University College of Osteopathic Medicine 1 ACKNOWLEDGEMENTS AND DISCLOSURES ïµ I would like to acknowledge the research, implementation, data analysis and publication contributions of Dr. Sweta Tewary (GEC) ïµ I have no financial disclosures Objectives ïµ Review the scope of foot problems and their consequences in people with diabetes ïµ Understand the need for interprofessional roles for foot care as suggested by practice guidelines ïµ Present protocol and results from the NSUCOM GEC Evidence-Based study on Diabetes Foot Education in the Long-term Care Setting ïµ Change in knowledge level and practice before and after training ïµ Determine the differences in patient outcomes through chart reviews before and after the training ïµ Examine the implications for practice 3 Epidemiology of Foot Problems in People with Diabetes ïµ 65 years and above -10.9 million/26.9 percent, have diabetes (CDC 2014) ïµ 15-25% will develop ulcers on their feet (Up to 50% of DPN may be asymptomatic, and patients are at risk for insensate injury to their feet) ïµ 20% of those with diabetes admitted to hospitals because of foot problems ïµ 5 year survival rate ~50% for BKA(O’Brian, 1997) ïµ Nearly $245 billion spent annually for direct and indirect medical costs (CDC 2014) ïµ Average cost of treatment of diabetic ulcer $28,000 (Boulton et al. NEJM 2004) 4 Neuroischemic ulcers ADA Recommendations for Foot Care 2015 ïµ For all patients with diabetes, perform an annual comprehensive foot examination to identify risk factors predictive of ulcers and amputations. The foot examination should in Continue reading >>

Does Medicare Cover Diabetic Foot Exams Or Podiatry Services?

Does Medicare Cover Diabetic Foot Exams Or Podiatry Services?

| Licensed since 2012 Print If you have been diagnosed with diabetes and are enrolled in Original Medicare (Part A and Part B), you may be eligible for coverage of regular foot exams and diabetic foot care, subject to certain requirements. Read on to learn more about your benefits. Why do I need a diabetic foot exam? According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 60 to 70 percent of people with diabetes develop a form of diabetic neuropathy, which is a type of nerve disorder caused by diabetes. The most common type of diabetic neuropathy is peripheral neuropathy, which may cause pain or loss of sensation in the toes, feet, legs, hands, or arms. Long-term exposure to the metabolic effects of high blood sugar may cause damage to the nerves, often concentrated in the toes, feet, and legs. This nerve damage may cause numbness, tingling, foot deformities such as hammertoes, and may even change the way a person walks. As a result, blisters and sores often develop on pressure points and may go unnoticed due to loss of sensation in the feet and toes. If these sores aren’t treated promptly, infections may develop and can lead to gangrene. If treatments don’t work, amputation may be required to prevent life-threatening complications. A diabetic foot exam by a podiatrist or provider certified in foot care can detect potential problems before they occur or develop into more serious conditions. According to the NIDDK, during a diabetic foot exam, your health-care provider will: Carefully inspect the feet for cracks, sores, signs of infection, and bony deformities. Test the feet for signs of nerve damage. Test blood flow to the feet and legs. Trim your toenails if you can’t trim your own. Show you how to care for your feet and m Continue reading >>

Comprehensive Foot Examination And Risk Assessment

Comprehensive Foot Examination And Risk Assessment

Go to: THE PATHWAY TO FOOT ULCERATION The lifetime risk of a person with diabetes developing a foot ulcer may be as high as 25%, whereas the annual incidence of foot ulcers is ∼2% (3–7). Up to 50% of older patients with type 2 diabetes have one or more risk factors for foot ulceration (3,6). A number of component causes, most importantly peripheral neuropathy, interact to complete the causal pathway to foot ulceration (1,3–5). A list of the principal contributory factors that might result in foot ulcer development is provided in Table 1. The most common triad of causes that interact and ultimately result in ulceration has been identified as neuropathy, deformity, and trauma (5). As identification of those patients at risk of foot problems is the first step in preventing such complications, this report will focus on key components of the foot exam. Go to: COMPONENTS OF THE FOOT EXAM History While history is a pivotal component of risk assessment, a patient cannot be fully assessed for risk factors for foot ulceration based on history alone; a careful foot exam remains the key component of this process. Key components of the history include previous foot ulceration or amputation. Other important assessments in the history (Table 2) include neuropathic or peripheral vascular symptoms (7,8), impaired vision, or renal replacement therapy. Lastly, tobacco use should be recorded, since cigarette smoking is a risk factor not only for vascular disease but also for neuropathy. General inspection A careful inspection of the feet in a well-lit room should always be carried out after the patient has removed shoes and socks. Because inappropriate footwear and foot deformities are common contributory factors in the development of foot ulceration (1,5), the shoes should be inspec Continue reading >>

Diabetic Foot Screening

Diabetic Foot Screening

> Main > Primary Health Care > Diabetic Foot Screening Screening offoot in diabetes is anessentialpart of the examination carried out by the Podiatry Department. The aim of this examination is to determine as early as possible any risk factors for diabetic foot complications such as neuropathy and ischaemia amongst other things, and reduce amputations and ulcerations with timely referrals. Studies have shown that early detection and intervention may prevent up to 85% of amputations in diabetic patients. It is important toinform the podologist if one is having any problems with their feet such as: The following should be reported immediately to your caring doctor/podologist: colour change -red hot skin which may alsobe swollen. Patients will be risk categorized and if indicated referred forfurther assessment. Patient care pathway for screening of patients for Diabetic foot complications. All patients attending the Diabetes clinics in all the health centres are obliged to have screening for the feet. The nurse leading the diabetes clinic will make sure that the screening actually takes place and the GP refers patient accordingly. All patients will undergo neurological and vascular assessment by the Podiatrists using the mono filament and Doppler ultrasound, The findings are recorded in the specified form DH 140. If initial assessment is certified to be normal then the patient is given a yearly appointment and referred back to the Diabetes Clinic. Patients who have gone through level one screening and found to have neuropathic or vascular problems are referred for more in depth screening at Floriana Health Centre. If further tests prove that the foot is not pathologically compromised, it will continue to be followed up at the Floriana Health Centre and expert advice is gi Continue reading >>

Your Annual Comprehensive Foot Exam

Your Annual Comprehensive Foot Exam

People with diabetes face the possibility of developing a variety of diabetic complications, with the risk of each dependent on a number of factors including, first and foremost, blood glucose control. One area in which complications can occur is the feet. It is estimated that as many as 25% of people with diabetes develop a foot ulcer at some point in their lives, and ulcer risk tends to increase with age. The major contributing factor to this risk is loss of sensation in the feet, usually caused by peripheral neuropathy, or nerve damage in the feet and legs. This common complication can change or reduce the sensation of pain, heat, and cold in the feet. For example, if someone with neuropathy were to walk on hot pavement, he might not be able to feel the heat, so there would be an increased likelihood of burns or blisters — which, in turn, could easily go unnoticed and untreated due to the lack of sensation. Add to the mix another common diabetic complication: reduced blood circulation in the limbs, or peripheral arterial disease. Blood is the main source of oxygen and other nutrients essential to healing, as well as immune defense, so when circulation is impaired, wounds tend to take longer to heal and are more likely to become infected. Thus, for feet, the combination of reduced sensation and poor circulation can spell major trouble. While these two factors tend to play the largest role in the development of foot complications, other factors can also increase the level of risk, including foot deformities, loss of eyesight, kidney disease, chronic or frequent high blood glucose, previous ulcers or amputation, and cigarette smoking. There is good news, however. Through early identification, diagnosis, and treatment of potential problems, the vast majority of foot-re Continue reading >>

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