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Karakousis ND, Pyrgioti EE, Georgakopoulos PN, Papanas N. Sarcopenia, Frailty and Diabetic Foot: A Mini Narrative Review. INT J LOW EXTR WOUND 2024; 23:499-503. [PMID: 35791577 DOI: 10.1177/15347346221111420] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this narrative mini review was to investigate the potential association of the diabetic foot (DF) with sarcopenia and frailty. Data is still limited, but it appears that DF patients may be more prone to frailty. In addition, patients with DF and sarcopenia exhibit more frequently foot ulcers and amputations, as well as increased mortality rates post-operatively. Further studies are now needed to see how these realizations may be used in clinical practice, aiming to improve DF outcomes.
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Affiliation(s)
| | | | | | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
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Haran C, Allan P, Dholakia J, Lai S, Lim E, Xu W, Hart O, Cain J, Narayanan A, Khashram M. The application and uses of telemedicine in vascular surgery: A narrative review. Semin Vasc Surg 2024; 37:290-297. [PMID: 39277344 DOI: 10.1053/j.semvascsurg.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/14/2024] [Accepted: 07/22/2024] [Indexed: 09/17/2024]
Abstract
Technological advances over the past century have accelerated the pace and breadth of medical and surgical care. From the initial delivery of "telemedicine" over the radio in the 1920s, the delivery of medicine and surgery in the 21st century is no longer limited by connectivity. The COVID-19 pandemic hastened the uptake of telemedicine to ensure that health care can be maintained despite limited face-to-face contact. Like other areas of medicine, vascular surgery has adopted telemedicine, although its role is not well described in the literature. This narrative review explores how telemedicine has been delivered in vascular surgery. Specific themes of telemedicine are outlined with real-world examples, including consultation, triaging, collaboration, mentoring, monitoring and surveillance, mobile health, and education. This review also explores possible future advances in telemedicine and issues around equity of care. Finally, important ethical considerations and limitations related to the applications of telemedicine are outlined.
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Affiliation(s)
- Cheyaanthan Haran
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Philip Allan
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand
| | - Jhanvi Dholakia
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand
| | - Simon Lai
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eric Lim
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand
| | - William Xu
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand
| | - Odette Hart
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Cain
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand
| | - Anantha Narayanan
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, 183 Pembroke Street, Hamilton 3204, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Formosa C, Chockalingam N, Gatt A, Papanas N. Diabetic Amputations in 2023 are Still More Frightening Than Death-Act Now Before it is Too Late. INT J LOW EXTR WOUND 2023:15347346231171439. [PMID: 37081813 DOI: 10.1177/15347346231171439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Despite huge medical and technological advances to date for the diagnosis, monitoring, and management of diabetic foot complications, their prevalence is still alarmingly high. Patients' quality of life may be severely compromised. Patients may fear amputations more than death. An effort to minimize the impact of these complications and to ensure prompt access to care for everyone is still required. Urgent therapeutic measures should become possible when needed. Improved physician training in and management of peripheral arterial disease are also vital. We need to act now before it is too late. This will definitely be one of the greatest challenges for 2023 and the years to come.
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Affiliation(s)
- Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Taylor L, Gangnon R, Powell WR, Kramer J, Kind AJH, Bartels CM, Brennan MB. Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study. BMJ Open Diabetes Res Care 2023; 11:11/2/e003185. [PMID: 37072336 PMCID: PMC10124219 DOI: 10.1136/bmjdrc-2022-003185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Rural patients with diabetic foot ulcers, especially those identifying as black, face increased risk of major amputation. Specialty care can reduce this risk. However, care disparities might beget outcome disparities. We aimed to determine whether a smaller proportion of rural patients, particularly those identifying as black, receive specialty care compared with the national proportion. RESEARCH DESIGN AND METHODS This 100% national retrospective cohort examined Medicare beneficiaries hospitalized with diabetic foot ulcers (2013-2014). We report observed differences in specialty care, including: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, or vascular surgery. We used logistic regression to examine possible intersectionality between rurality and race, controlling for sociodemographics, comorbidities, and ulcer severity and including an interaction term between rurality and identifying as black. RESULTS Overall, 32.15% (n=124 487) of patients hospitalized with a diabetic foot ulcer received specialty care. Among rural patients (n=13 100), the proportion decreased to 29.57%. For patients identifying as black (n=21 649), the proportion was 33.08%. Among rural patients identifying as black (n=1239), 26.23% received specialty care. This was >5 absolute percentage points less than the overall cohort. The adjusted OR for receiving specialty care among rural versus urban patients identifying as black was 0.61 (95% CI 0.53 to 0.71), which was lower than that for rural versus urban patients identifying as white (aOR 0.85, 95% CI 0.80 to 0.89). This metric supported a role for intersectionality between rurality and identifying as black. CONCLUSIONS A smaller proportion of rural patients, particularly those identifying as black, received specialty care when hospitalized with a diabetic foot ulcer compared with the overall cohort. This might contribute to known disparities in major amputations. Future studies are needed to determine causality.
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Affiliation(s)
- Lindsay Taylor
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald Gangnon
- Population Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - W Ryan Powell
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
| | - Joseph Kramer
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
| | - Amy J H Kind
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- University of Wisconsin Center for Health Disparities Research, Madison, Wisconsin, USA
| | | | - Meghan B Brennan
- Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Kamaratos-Sevdalis N, Kamaratos A, Papadakis M, Tsagkaris C. Telehealth has comparable outcomes to in-person diabetic foot care during the COVID-19 pandemic. World J Methodol 2022; 12:285-292. [PMID: 36159092 PMCID: PMC9350733 DOI: 10.5662/wjm.v12.i4.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/19/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has posed obstacles to the delivery of diabetic foot care. In response to this remote healthcare services have been deployed offering monitoring, follow-up, and referral services to patients with diabetic foot ulcers and related conditions. Although, remote diabetic foot care has been studied before the COVID-19 pandemic as an alternative to in-person care, the peculiar situation of the pandemic, which dictates that remote care would be the sole available option for healthcare practitioners and patients, necessitates an evaluation of the relevant knowledge obtained since the beginning of the severe acute respiratory syndrome coronavirus 2 outbreak.
AIM To perform a thorough search in PubMed/Medline and Cochrane to identify original records on the topic.
METHODS To identify relevant peer-reviewed publications and gray literature, the authors searched PubMed-MEDLINE and Cochrane Library-Cochrane Central Register of Controlled Trials starting September 27 till October 31, 2021. The reference lists of the selected sources and relevant systematic reviews were also hand–searched to identify potentially relevant resources. Otherwise, the authors searched Reference Citation Analysis (https://www.referencecitationanalysis.com/).
RESULTS A number of randomized prospective studies, case series, and case reports have shown that the effectiveness of remote care is comparable to in-person care in terms of hospitalizations, amputations, and mortality. The level of satisfaction of patients’ receiving this type of care was high. The cost of remote healthcare was not significantly lower than in - person care though.
CONCLUSION It is noteworthy that remote care during the COVID-19 pandemic appeared to be more effective and well - received than remote care in the past. Nevertheless, larger studies spanning over longer time intervals are necessary in order to validate these results and provide additional insights.
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Affiliation(s)
- Nikolaos Kamaratos-Sevdalis
- Diabetic Foot Clinic, Diabetes Center and 1st Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Piraeus 18536, Greece
| | - Alexandros Kamaratos
- Diabetic Foot Clinic, Diabetes Center and 1st Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Piraeus 18536, Greece
| | - Marios Papadakis
- Surgery II, University of Witten-Herdecke, Wuppertal 42283, Germany
| | - Christos Tsagkaris
- Diabetic Foot Clinic, Diabetes Center and 1st Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Piraeus 18536, Greece
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Papanas N, Papi M, Rerkasem K. Sweet Sunshine of Science. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2022; 21:105-106. [PMID: 35469456 DOI: 10.1177/15347346221096031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
| | - Massimo Papi
- National Institute for Health, Migration and Poverty (NIHMP), ADOI National Study Group Vulnology and Vascular Dermatology, Rome, Italy
| | - Kittipan Rerkasem
- Environmental-Occupational Health Sciences and Non Communicable Diseases Research Group, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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