https://nova.newcastle.edu.au/vital/access/ /manager/Index en-au 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:50246 Wed 28 Feb 2024 15:28:44 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:45059 p = 0.02) to substantial (graduated tuning fork, К: 0.68, CI: 0.41–0.95, p < 0.01). The 10-site monofilament (К: 0.44–0.77) outperformed the 4-site test (К: 0.34–0.67) and the dampened tuning fork method (К: 0.41–0.49) showed lower intra-rater reliability compared to both conventional (К: 0.52–0.57) and graduated methods (К: 0.50–0.57). Conclusion: We support the current recommendations of using more than one test to screen and monitor progression of DPN. Four- and 10-site 10 g monofilament testing have similarly acceptable levels of reliability and the neurothesiometer is the most reliable method of assessing vibration perception function. Use of a graduated tuning fork was slightly more reliable than other methods of tuning fork application however all had substantial reliability. Years of clinical experience only marginally affected test reliability overall and due to subjective nature of the tests we suggest that testing should be performed regularly and repetitively.]]> Wed 26 Oct 2022 12:09:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:48550 Wed 22 Mar 2023 08:59:17 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:48351 Wed 15 Mar 2023 09:56:37 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46353 p < 0.001) and CLTI (p < 0.001) in the most deprived areas, and cold spots for PAD (p < 0.001) but not CLTI (p = 0.72) in the least deprived areas. Major health disparities in PAD/CLTI diagnoses in people with diabetes is driven by socioeconomic deprivation.]]> Wed 13 Mar 2024 08:56:31 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:22591 Wed 11 Apr 2018 16:12:31 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23425 Wed 11 Apr 2018 13:09:54 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:25729 Wed 11 Apr 2018 12:05:09 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:22838 Wed 11 Apr 2018 09:38:55 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:31231 75% stenosis) in control group (80.77%). Conclusions: Our findings indicate that TPs are useful to assist in diagnosing PAD in clinical practice, however, results should be interpreted with caution due to the small probability of PAD being present with a negative test.]]> Wed 11 Apr 2018 09:21:58 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:49278 12 weeks' duration8. Chronic DFU patients are more likely to undergo amputation as they are more prone to infection and wound deterioration over time5. AIMS: In order to determine which factors are contributing most to delayed healing in patients with DFU, we need to conduct a prospective cross-sectional study that will measure all of the major factors implicated in wound chronicity in DFU (Figure 1) and determine the effect each of these have on wound Wound Practice and Research 112 healing time and outcomes, including amputation. Therefore the aims of our study are primarily to assess factors contributing to healing outcomes and wound chronicity in people with DFU and secondarily to measure dietary intake in patients with DFU in an Australian setting. METHOD: Participants with diabetes (type 1 and 2) and current DFU attending a public health podiatry clinic will be included and will attend a single testing session. Exclusion criteria will include a contraindication for placement of the toe cuff around the hallux or second digit, previous bilateral mastectomy preventing brachial blood pressure examination, vasospastic disorders, an inability to adhere to the testing protocol, and/or an inability to give informed consent. During a 12-month period it is expected 144 participants will be from across three sites (Hunter New England High Risk Foot Clinic, Wyong High Risk Foot Clinic and Gosford High Risk Foot Clinic), with 60 participants recruited to date. In order to determine which factors are contributing to delayed healing outcomes, a number of variables will bemeasured. A current general medical history will be obtained from the participants’ general practitioner, including current medication, concurrent chronic disease status, overall general medical history and diabetes duration, type (1 or 2), and current HbA1c levels. HbA1c levels are reflective of glycaemia over 2-3 months and are associated with wound healing rates in patients with diabetes. Higher HbA1c levels are associated with poorer healing outcomes – with each 1.0% increase in HbA1c, a daily reduction in wound healing of 0.028 cm2 can be expected9. Demographic data, including age, gender and smoking status, will also be collected. Nicotine is a vasoconstrictor which reduces skin blood flow, resulting in localised tissue ischaemia and impaired healing capability10. Smoking has therefore been clinically associated with general delayed healing; however, extensive controlled studies are yet to be undertaken in DFU. This study will determine if – and to what level – smoking has an effect on healing outcomes in DFU. Lower limb vascular assessment will include systolic toe pressure measurement along with a toe-brachial pressure index, both of which have been demonstrated as accurate indicators of PAD in patients with diabetes11,12. The presence of PAD and its negative impact on healing capacity is frequently underestimated, with the presence of ischaemia within a DFU not always obvious. That is, whilst purely ischaemic ulcers are readily identified by their characteristic appearance, symptoms and location, neuro-ischaemic DFUs can be more subtle in presentation13,14. This study will therefore aim to establish how much impact PAD has on healing outcomes in DFU. An assessment of dietary intake will also be conducted by using the Australian Eating Survey (AES), a valid and reproducible method of quantifying dietary intake15 that assesses usual food and nutrient intake over the preceding 3-6 months. Wound healing requires adequate dietary intake, with poor healing outcomes associated with deficiencies in nutrition16. Nutrition deficiencies can negatively impact Fig 1: Factors influencing wound chronicity in DFU Chronic diabetic foot ulceration Foot deformity/ Offloading Vascular Supply Peripheral neuropathy Glycaemic Control Wound Severity Infection Physical factors including smoking, BMI Dietary IntakeFigure 1. Factors influencing wound chronicity in DFU Tehan et al. Factors contributing to wound chronicity in diabetic foot ulceration 113 Volume 27 Number 3 – September 2019 wound healing by prolonging the inflammatory phase, decreasing fibroblast proliferation, and altering collagen synthesis17. However, dietary intake in patients with DFU has not yet been determined in an Australian cohort. With such variation in regional dietary intake, it is important that this can be established. Presence of infection will be determined by the International Working Group for the Diabetic Foot (IWGDF) guidelines for infection and will be collected by the treating podiatrist. Infection remains the most frequent diabetes complication requiring hospitalisation, and the most common precipitating event leading to lower extremity amputation18. This study will determine how much impact infection has on healing outcomes in DFU. Self-reported physical activity levels will be determined using the International Physical Activity Questionnaire (IPAQ), a validated research tool to determine physical activity levels19. Weight-bearing activity influences the amount of mechanical trauma in the plantar surface of the foot, and is a contributor to DFU20. Presence of foot deformity will also be collected, along with offloading intervention type, and wound education will be given. Current guidelines recommend that patients with DFU reduce their weight-bearing activities, in addition to wearing an offloading device to assist with healing21. Waist circumference will be determined using a tape measure, and weight and height measurements will also be taken to determine patients' body mass index. Obesity is associated with higher rates of post-operative wound infection, with reductions in tissue perfusion proposed as one contributing factor – adipose tissue is poorly vascularised and a reduction in collagen production is also frequently seen22. However, it is currently unclear how obesity impacts wound healing in patients with DFU. Neurological assessment will be performed using a combination of two tests, including a four-site monofilament test and measurement of vibration perception threshold by a neurothesiometer at the hallux. Ascertaining neurological status will help inform the aetiology of the DFU. Wound grade will be determined using University of Texas wound grade classification for DFU which involves assessing the size, depth and duration of the wound. Higher wound grades in chronic DFU are associated with higher rates of non-healing 23. Follow-up with participants regarding their wound healing will be completed at regular intervals through a clinical note audit at 3 and 6 months after the initial assessment, where wound size will be compared to the initial wound measurement.]]> Wed 10 May 2023 12:24:20 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:38152 1 on the RAND/UCLA disagreement index from round two. Results: Fifty-eight items (n = 58) were generated for rating and at the end of three iterative rounds, there was agreement that thirty-eight items were important, that two were not important, and there was no agreement for a further eighteen items. Item themes reaching consensus included footwear characteristics and acceptability and psychosocial aspects of footwear. Footwear characteristics related to heel height, shape, cushioning, toe box size, adjustable fastening, removable insoles, mid-foot support and soft accommodative uppers. Acceptability and psychosocial aspects included affordability, comfort, aesthetic, style, colour and impact on femininity. Conclusion: This consensus exercise has identified the important features of retail footwear for women with RA.]]> Wed 04 Aug 2021 17:55:34 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:37741 0.2, with one study reporting a higher value of 0.8. Main conclusions: Successful post-amputation healing outcomes were reported at mean toe systolic blood pressure ⩾30 mmHg, and the results varied considerably between the studies. Further research should identify whether variables, including amputation level, method of wound closure and length of post-operative follow-up periods, affect the values of toe systolic blood pressure and toe-brachial pressure index observed in this review.]]> Wed 03 Aug 2022 10:31:15 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:24870 Thu 28 Oct 2021 13:05:13 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:45369 Thu 27 Oct 2022 15:02:10 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:35451 Thu 13 Jan 2022 10:28:13 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:46048 Thu 10 Nov 2022 10:14:32 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42754 Thu 01 Sep 2022 14:56:24 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23955 Sat 24 Mar 2018 07:10:07 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52711 Mon 23 Oct 2023 16:11:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:55356 Mon 19 Aug 2024 18:28:20 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42604 20% compared to resting ABI, an ABI value of ≤0.90 postexercise, or a reduction in systolic ankle pressure of >30 mmHg postexercise. This retrospective study used colour duplex ultrasound (CDU) as the reference standard. In 278 limbs (whole group), the resting ABI had an overall area under the curve (AUC) of 0.71, with the postexercise ABI yielding a similar diagnostic accuracy of AUC 0.72. In the non-diabetes group (n=171), the resting ABI had an overall AUC of 0.74 and the postexercise ABI had a similar AUC of 0.76. In the diabetes group (n=107), overall accuracy was reduced compared to the non-diabetes group, with the resting ABI having an overall AUC of 0.65 and the postexercise ABI yielding a similar accuracy with an AUC of 0.64. The overall diagnostic accuracy of the postexercise ABI for diagnosing PAD was not greatly improved compared to resting ABI. Given the lower overall diagnostic accuracy in the diabetes group, both the resting and the postexercise ABI results in diabetes populations should be interpreted with caution. There is a risk of undiagnosed disease if relying on these results alone to determine lower limb vascular status.]]> Fri 26 Aug 2022 15:54:26 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:53204 Fri 17 Nov 2023 11:57:59 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:44525 Fri 14 Oct 2022 13:58:33 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41807 Fri 12 Aug 2022 12:31:40 AEST ]]>