https://nova.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:37177 Wed 26 Aug 2020 16:22:46 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7934 Wed 11 Apr 2018 13:12:02 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23048 Wed 11 Apr 2018 11:36:49 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:34422 Wed 04 Sep 2019 10:27:38 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:34421 Wed 04 Sep 2019 09:55:56 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:36394 Tue 07 Apr 2020 15:53:48 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:36389 Tue 07 Apr 2020 14:29:30 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:36133 Thu 28 Oct 2021 12:36:52 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:40278 Thu 28 Jul 2022 13:54:47 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:36190 measured during nighttime ambulatory BP monitoring (ABPM) and basal MAP estimated using a standardized protocol. Materials and methods: For a cohort of 137 consecutive patients, aged ≥40 years, who recently underwent ABPM, a blinded investigator estimated basal MAP from up to five most recent clinic BP measurements. Both basal MAP values, measured and estimated, were compared pairwise for each participant. Results: We traced a median of 4 [interquartile range 3-5] previous BP measurements per patient over a median period of 132 [interquartile range 55-277] days up until the ABPM test. The estimated basal MAP (mean 88 ± 8 mmHg) was linearly related (Pearson's r = 0.41, p = 0.0001) to the measured basal MAP (mean 88 ± 12 mmHg). Bland-Altman plot revealed a mean bias of 0.3 mmHg with agreement limits of ±22 mmHg. Conclusions: The mean bias between estimated and measured values for basal MAP was insignificant and modest. When a recent nighttime ABPM is unavailable, a protocol based on recent clinic BP readings can be used to estimate patient's basal MAP. Study registration: Australian New Zealand Clinical Trials Registry ACTRN12613001382763.]]> Thu 27 Feb 2020 09:35:33 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:32973 Thu 24 Mar 2022 11:35:18 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23946 Thu 13 Aug 2020 08:44:39 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:31824 Sat 24 Mar 2018 08:43:06 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:2999 Sat 24 Mar 2018 08:33:06 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:13371 Sat 24 Mar 2018 08:18:44 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10667 Sat 24 Mar 2018 08:12:09 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19846 Sat 24 Mar 2018 07:57:06 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:6137 Sat 24 Mar 2018 07:44:33 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:25704 Sat 24 Mar 2018 07:28:21 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:4072 Sat 24 Mar 2018 07:18:20 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:22658 Sat 24 Mar 2018 07:15:38 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:43602 n = 12) using two in-field approaches: validation by on-ground observer (n = 10) and validation using 4K footage captured and reviewed directly after the survey (n = 2). We also provide detectability considerations relative to survey time, temperature, wildlife–RPAS interactions and detection of non-target species, which can be used to further inform RPAS survey protocols.]]> Mon 26 Sep 2022 15:26:50 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:33247 7 cutpoint identified in 2014 for the BP and STI endpoints. A tertiary objective of the trial is to determine whether intercurrent medical conditions will impact independently on delayed radiotherapy morbidity and other treatment related morbidity.]]> Mon 23 Sep 2019 13:37:53 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:36137 Fri 14 Feb 2020 14:48:05 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23092 Fri 09 Aug 2019 14:04:14 AEST ]]>