Description
Angela is a Chiropodist/Podiatrist in private practice. Based at the Melior Clinic in Huntingdon, she is available for consultations and treatments. Angela who has been in private practice for over 23 years is based two days a week at the Melior Clinic in St Peter's Rd, Huntingdon. She is very interested in continuing professional development and enjoys sharing medical journals and scholarly documents she has access to with colleagues and the general public. These usually are about feet - but not always!!
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http://www.practiceupdate.com/c/34541/2/6/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_primary&elsca4=primary-care&elsca5=newsletter&rid=ODk3Nzg4MTg2NDIS1&lid=10332481 Published in Primary Care Journal Scan / Review · February 02, 2016 High-Heeled Shoes and Musculoskeletal Injuries BMJ Open TAKE-HOME MESSAGE The association between wearing high-heeled shoes and the development of musculoskeletal pathology was assessed in this systematic review of 18 studies. The researchers found an association between high-heeled shoes and hallux valgus in three of four articles, an association with pain in three of five articles, with first-party injury in seven of eight articles, and with osteoarthritis in neither of two articles. Wearing high-heeled shoes appears to be associated with hallux valgus, pain, and injury, but not osteoarthritis. abstract This abstract is available on the publisher's site. OBJECTIVES To conduct the first systematic review from an epidemiological perspective regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, osteoarthritis (OA) and both first-party and second-party injury in human participants without prior musculoskeletal conditions. SETTING A systematic review of international peer-reviewed scientific literature across seven major languages. DATA SOURCES Searches were conducted on seven major bibliographic databases in July 2015 to initially identify all scholarly articles on high-heeled shoes. Supplementary manual searches were conducted. Titles, abstracts and full-text articles were sequentially screened to identify all articles assessing epidemiological evidence regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, OA and both first-party and second-party injury in human participants without prior musculoskeletal conditions. Standardised data extraction and quality assessment (Threats to Validity tool) were conducted. PRIMARY AND SECONDARY OUTCOME MEASURES Musculoskeletal pain or OA as assessed by clinical diagnosis or clinical assessment tool. First-party or second-party injury. RESULTS 644 unique records were identified, 56 full-text articles were screened and 18 studies included in the review. Four studies assessed the relationship with hallux valgus and three found a significant association. Two studies assessed the association with OA and neither found a significant association. Five studies assessed the association with musculoskeletal pain and three found a significant association. Eight studies assessed first-party injury and seven found evidence of a significant injury toll associated with high-heeled shoes. One study provided data on second-party injury and the injury toll was low. CONCLUSIONS High-heeled shoes were shown to be associated with hallux valgus, musculoskeletal pain and first-party injury. No conclusive evidence regarding OA and second-party injury was found. Societal and clinical relevance of these findings is discussed. Concern is expressed about the expectation to wear high-heeled shoes in some work and social situations and access by children.
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http://www.practiceupdate.com/c/34733/2/4/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_derma&elsca4=dermatology&elsca5=newsletter&rid=ODk3Nzg4MTg2NDIS1&lid=10332481## Published in Dermatology Journal Scan / Research · February 02, 2016 Early Symptoms and Long-Term Clinical Outcomes of Distal Limb's Cutaneous Arteriovenous Malformations Journal of the European Academy of Dermatology and Venereology : JEADV TAKE-HOME MESSAGE This retrospective study included 19 adult patients with distal limb arteriovenous malformations (AVM) whose records were reviewed, of whom 13 were followed for a median of 57.6 months, and of whom 15 were given a telephone questionnaire. More patients (15) had hand AVM than had foot AVM (4 patients). The most common initial symptoms included swelling and pain (experienced by almost half of participants, followed by venous dilations (37% of patients), changes in skin color, a pulsating sensation, and local hyperthermia. Of the 19 patients, 17 underwent treatment including embolotherapy sessions (53%), surgery (12%), or both (35%). Of the patients contacted for follow-up, 4 were in complete remission, 4 had partial remission, 2 had relapsed, and 3 had failed treatment. At follow-up, digital or hand amputation had been required for 7 patients and 8 patients were considered symptomatic and/or unstable. Distal limb AVMs are associated with a poor prognosis and can impact function of the hands and feet. In this study, the median delay between symptom onset and diagnosis was 9 years. Timely diagnosis should be made, keeping in mind that early symptoms can be subtle and may include swelling, pain, or both. Patients may sometimes present with a large vein. Only about two-thirds of patients have skin color changes. – Sarah Churton, MD abstract This abstract is available on the publisher's site. INTRODUCTION Cutaneous arterio-venous malformations (AVM) are high-flow vascular malformations made up of a direct link between arteries and veins without intermediary capillary space. 'Distal limb's AVM', which mean involving hands or feet, are rare and their functional prognosis is often poor. Little is known about their early clinical symptoms. The objectives of this study were to identify early clinical symptoms of distal limb's cutaneous AVMs and to determine their long-term clinical outcome. METHODS A retrospective study was carried out including adult patients who had distal limb's AVM, who were followed up between January 2000 and November 2013 in two regional tertiary care centres. The information was collected from patients' clinical records and completed by a structured telephone questionnaire. RESULTS Nineteen patients were included in the study: four (21%) with foot AVM and 15 (79%) with hand AVM. The first clinical symptoms were as follows: swelling (47%), pain (47%), one or several venous dilatations (37%) and rarely abnormal skin colour, hyperthermia and pulsating sensation. The median diagnosis delay was 9 years after the onset of first manifestations. Amongst the 17 patients who underwent a treatment, 53% had embolotherapy session(s), 12% surgery and 35% had both. After an average follow-up of 57.6 months, 31% of the 13 patients contacted who were receiving treatment were in complete remission; 31% had partial remission; 15% had relapse after initial improvement and 23% had treatment failure. Overall, 74% of patients had a serious development of the AVM: 37% had digital or hand amputation, and 42% remained symptomatic and/or unstable. CONCLUSION This study suggests that initial manifestations of distal limb's AVMs are discreet and non-specific, leading to a diagnosis delay of about 10 years, with poor prognosis. Doctors should evoke the diagnosis earlier, when these symptoms are shown: pain and/or swelling, sometimes with a large vein.
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http://www.practiceupdate.com/c/34771/2/4/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_derma&elsca4=dermatology&elsca5=newsletter&rid=ODk3Nzg4MTg2NDIS1&lid=10332481 Published in Dermatology Journal Scan / Research · February 03, 2016 Risk Factors and Outcomes of Cutaneous Melanoma in Women Less Than 50 Years of Age Journal of the American Academy of Dermatology 2 Expert Comments TAKE-HOME MESSAGE This retrospective study of 462 female patients <50 years old (mean age, 34.7) diagnosed with melanoma between 1988 and 2012 assessed risk factors and outcomes in those followed for more than 2 years. Patients in the youngest age category (<19 years) were less likely to have invasive melanoma than those in other age categories. The 40- to 49-year age group had the higher recurrence rates, metastatic disease, positive sentinel node status, and death rates compared with the other age groups. Pregnancy-associated melanoma (PAMM) was diagnosed in 41 patients. Patients with PAMM had a 9.2 increase in the odds of recurrence (based on 11 recurrences total in the study), a 6.7 increase in the odds of metastasis, and a 5.1 increase in the odds of mortality compared with non-pregnant patients. This study revealed that women with PAMM (diagnosed with melanoma while pregnant or within 1 year following delivery) had higher rates of metastasis, recurrence, and death compared with non-pregnant patients. This finding suggests that routine skin exams during and after pregnancy should be recommended. – Sarah Churton, MD Dermatology Written by Jane Grant-Kels MD This retrospective, single-center, tertiary care, hospital-based review studied 462 women with melanoma less than 50 years of age (mean age, 34.7 years). Unfortunately, there was no control group. The authors concluded that those women 40 to 49 years old had a higher incidence of positive sentinel lymph nodes, recurrence rates, metastatic disease, and death rates. Of the 462 women, 41 were labeled as having PAMM (pregnancy-associated malignant melanoma), which was “arbitrarily defined as melanoma diagnosed during pregnancy or within 1 year after delivery.” Of the 41 women, 19 were actually diagnosed with melanoma during their pregnancies. This subgroup of 41 was compared with the other women in the study who were considered the “control group” as they were not pregnant and had not given birth within 1 year of diagnosis. Most importantly, the authors reported that the women with PAMM had a significantly worse prognosis, with a ninefold increase of recurrence, sevenfold increase in metastasis, and a fivefold increase in mortality. Control non PAMM Group Most previous studies on PAMM focus on women who are diagnosed with melanoma during pregnancy and do not include the those in the postpartum period. Additionally, the findings of this study are in striking contrast with the overwhelming majority of previous studies that do not show a negative impact of pregnancy on melanoma. The authors postulate the following reasons for their findings: 1) The hospital was a tertiary care medical center that might attract more complex cases. 2) Pregnant women may have a possible delay in diagnosis of their melanoma. 3) It is possible that there is a biologic mechanism that results in a more aggressive behavior of the melanoma. Studies on tamoxifen therapy and infertility treatments, however, have not demonstrated a negative role of estrogen in melanoma. 4) Pregnancy induced immunosuppression might be the cause of the more aggressive melanoma behavior. 5) Pregnancy-associated increase in intratumoral lymphangiogenesis, documented by others, could result in an enhanced metastatic potential of melanoma during pregnancy. The weakness of this study includes the absence of a true control group and the fact that the study was performed at a tertiary care center, which tends to attract more complex patients. The important bottom line is that pregnant women need to be aware of their skin. Patients and physicians need to be aware that any changing lesion in a pregnant woman must be examined carefully. If any suspicious features are identified, the lesion should be biopsied, excised, or the patient should be referred to a dermatologist for a second opinion. Dermatology Written by Blank Author JAAD Fig 3 abstract This abstract is available on the publisher's site. BACKGROUND Melanoma is the fifth most common cancer in the United States, with recent reports indicating increasing incidence among young women. OBJECTIVE This study sought to investigate histopathology, staging, risk factors, and outcomes of cutaneous melanoma in women younger than 50 years. METHODS All female patients aged up to 49 years with biopsy-proven diagnosis of melanoma between 1988 and 2012 were included. Patients with a follow-up of less than 2 years were excluded. RESULTS A total of 462 patients were identified, with mean age of 34.7 years. Invasive melanoma was less common in women 19 years of age or younger (P < .0008). Positive sentinel node status (P < .008), recurrence rates, metastatic disease (P < .001), and death rates (P < .008) were higher for women ages 40 to 49 years. The 41 patients with a pregnancy-associated melanoma had a significantly worse prognosis in comparison with a control group of nonpregnant patients, with a 9-fold increase in recurrence (P < .001), 7-fold increase in metastasis (P = .03) and 5-fold increase in mortality (P = .06). LIMITATIONS This was a retrospective study. CONCLUSION The increasing incidence of melanoma for women younger than 50 years suggests that regular skin checks and self-examinations are warranted. In addition, in women given the diagnosis of melanoma during or within 1 year after childbirth, regular follow-up and monitoring for recurrence are recommended.
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http://www.practiceupdate.com/c/34823/2/4/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_derma&elsca4=dermatology&elsca5=newsletter&rid=ODk3Nzg4MTg2NDIS1&lid=10332481 Published in Dermatology Expert Opinion / Commentary · February 03, 2016 “D” for Dark in the ABCDE Criteria for Melanoma—A Special Commentary by Stuart M Goldsmith, MD Written by Stuart M Goldsmith MD In April 2015, the American Academy of Dermatology (AAD) published the findings of the ad hoc task force concerning the ABCDEs of melanoma detection.1 This article is, to me, a top-ten practice-changer of 2015. It is important because it ties the past to the present and suggests a way forward to the future. The past is reflected by a number of articles inspired by the New York University group who devised the ABCDs and an article by the editor-in-chief of PracticeUpdate Dermatology emphasizing the addition and importance of “E”—evolution and changing.2 I share the same grand obsession with so many dermatologists, the desire to save lives by diagnosing melanoma as early as possible. However, further evolution is required in our thinking about the ABCDE criteria. My request in 2013 to Dirk Elston when he was president of the AAD led to the formation of an ad hoc committee to review the ABCDE criteria. The committee’s findings were published in the April 2015 issue of the Journal of the American Academy of Dermatology.1 Even though there has been a bias within the AAD to reject any changes to the ABCDE criteria not supported by the criteria developers, the committee in 2015 did conclude the following: To our knowledge, no randomized clinical trial has been performed to demonstrate that using the ABCDE criteria improves the ability to perform early detection by the public. Further research will be important to determine if the ABCDE criteria should be altered or set aside in favor of a newer paradigm. Many questions remain unanswered including dermatologists’ and primary care physicians’ use of the ABCDE criteria to educate their patients, their usefulness as a public health message and self-detection tool for laypersons, and if early detection can be enhanced by using the ABCDEs in parallel with other tools and approaches.1 In a response to a letter to the editor that I coauthored3 discussing some of my concerns about the committee summary, the authors of the summary acknowledged, “Going forward, more substantial research may in fact alter the ABCDEs. However, at the current writing, there does not appear to be enough evidence to warrant a change just yet.”4 The significance of these statements is that, finally, in 2015, the AAD acknowledged the absence of definitive evidence for the current ABCDE criteria and, in addition, indicated some acceptance that sufficient evidence to support a change may be forthcoming. Even though the above acknowledgements reflect some progress, I think the evidence and logic for a number of changes in the clinical approach to melanoma diagnosis are already overwhelming. I have recently reviewed these; however, two of the major changes are 1) the addition of “dark” as a screening feature and 2) a “D” for “dark” change in the ABCDE criteria.5-6 The relevance to the paper of 19992 is this: five examples of melanoma were discussed for which the ABCD criteria were inadequate, and the conclusion was that an increased emphasis on change (adding the “E” for evolution to the ABCDs) would overcome the deficiencies. What strikes me when I look at all five examples, however, is how much earlier the patients may have come in (including the patient who died—who came in because the lesion changed and was tender; but that wasn’t early enough) if, first, there was no diameter criterion at all, and, second, if the feature of darkness was known by patients to be of particular concern. In a way, the failure to mention this objective feature in the examples provided is a form of proof of the potential value of the darkness criterion. A principle of physical diagnosis in general, and of melanoma diagnosis in particular, is that “one finds what one looks for.” The authors omit discussion of what I perceive as obvious in the melanoma examples—that the dominant, easily perceived, objective feature of these melanomas is their intensity of pigment. The addition of “dark” as a screening feature uniquely enhances the utility of the primary screening strategies currently utilized of evolution/change recognition and ugly duckling identification. In summary, I believe the articles that I have quoted above are practice-changers in 2015. Nonetheless, in 2016, if one looks for these articles, I surely hope that additional evidence will be offered that supports a rejection of the diameter criterion and an increased emphasis on darkness in the approach to melanoma diagnosis. Nothing could be more important to the field of dermatology than providing information that gives individuals their best chance not to die from this cancer.
Central Nervous System May Contribute to Diabetic Peripheral Neuropathy
http://www.endocrinologyadvisor.com/diabetes/cns-contributes-to-diabetic-peripheral-neuropathy/article/470610/?DCMP=EMC-endo_update&cpn=&hmSubId=zaJJU4x4JKs1&NID=&spMailingID=13667610&spUserID=NTcwODk3MzkyNjQS1&spJobID=720365406&spReportId=NzIwMzY1NDA2S0 CJ Arlotta February 02, 2016 Central Nervous System May Contribute to Diabetic Peripheral Neuropathy Share this article: facebook twitter linkedin google Comments Email Print CNS factors might explain the development of diabetic peripheral neruopathy. CNS factors might explain the development of diabetic peripheral neruopathy. One of the key contributors to peripheral nerve disease in patients with diabetes is the central nervous system (CNS), a new report suggests. Published in the journal Pain, the study, conducted by Dr Solomon Tesfaye of Sheffield (UK) Teaching Hospitals NHS Foundation Trust and colleagues, outlines additional insights that examine the role of the CNS in the development of diabetic peripheral neuropathy. "Although [diabetic peripheral neuropathy] has been considered a disease of the peripheral nerve, from numerous studies it is becoming apparent that there are indeed changes within the CNS that … appear to be concomitant with the evolution of painful and painless [diabetic peripheral neuropathy]," the researchers wrote. Reviewing evidence resulting from the use of advanced imaging techniques in several studies, Dr Tesfaye and colleagues determined that CNS factors might explain the development of diabetic peripheral neuropathy. Key findings from the report include the following: Differences in the cross-sectional area (width) of the spinal cord, particularly before symptoms of diabetic peripheral neuropathy have appeared. Loss of volume (atrophy) in the primary sensory cortex — the main brain area involved in sense of touch. Differences in blood supply in a part of the brain called the thalamus — oversupply (hyperperfusion) in painful diabetic peripheral neuropathy, compared with undersupply (hypoperfusion) in painless diabetic peripheral neuropathy. Changes in higher brain areas, specifically the "pain processing matrix" — thought to be involved not only in detecting the location and intensity of pain but also the emotional responses. Reductions in the brain gray matter, particularly in areas where "somatosensory perceptions" are processed. "Imaging may help us to unravel one of the fundamental unanswered questions — where can the primary pathophysiology of the painful symptomatology of [diabetic peripheral neuropathy] be found?" the researchers wrote. "They hope that further detailed MRI studies "may lead to development of more rational therapies to help reduce the burden of [diabetic peripheral neuropathy]."
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Imported From IE Links https://ieonline.microsoft.com/#ieslice https://web.megameeting.com/emaillogin/ https://www.mozilla.org/about/?utm_source=about-home&utm_medium=Referral Pros and cons of hydrocolloid dressings for diabetic foot ulcers http://woundcareadvisor.com/pros-and-cons-of-hydrocolloid-dressings-for-diabetic-foot-ulcers/ By Kristine Hoffman, DPM, FACFAS Diabetic foot ulcers stem from multiple factors, including peripheral neuropathy, high plantar pressures, decreased vascularity, and impaired wound healing. Contributing significantly to morbidity, they may cause limb loss and death. (See Foot ulcers and diabetes.) Initially, hydrocolloid dressings were developed to function as part of the stomal flange. Based on their success in protecting peristomal skin, they were introduced gradually into other areas of wound care. They contain wafers of gel-forming polymers, such as gelatin, pectin, and cellulose agents, within a flexible water-resistant outer layer. The wafers absorb wound exudate, forming a gel and creating a moist healing environment. The wide range of hydrocolloid dressings available include fibrous and matrix dressings. Commercially available products include DuoDerm®, Granuflex®, Comfeel®, Cutimed® Hydro, and CovaWound™. Benefits Hydrocolloid dressings are occlusive, retaining wound exudate and promoting the moist environment that’s optimal for wound healing. They also promote autolytic wound debridement, removing necrotic tissue—a barrier to wound healing—from the wound bed. Wet or moist wound environments promote re-epithelialization, reduce inflammatory reactions, and decrease scar formation. Hydrocolloid dressings also aid wound healing by retaining growth factors in the exudate, promoting granulation tissue formation and epithelialization. (View hydrocolloid dressings) Although these dressings are contraindicated for patients with infected ulcers, they’re useful in preventing wound infection, serving as a barrier that prevents bacterial entry into diabetic foot ulcers. In addition, they promote a low pH, which reduces or even eradicates certain bacteria (namely Pseudomonas aeruginosa) from the wound bed. Hydrocolloid dressings are self-adherent and easy to apply. The second most popular dressing for diabetic foot ulcers, they can be left intact up to 7 days, depending on the amount of wound exudate. The need for less frequent dressing changes can reduce disruption of healing, improve patient compliance, and decrease cost. Disadvantages Controversy exists over the use of hydrocolloid dressings for treating diabetic foot ulcers. Many wound care experts suspect they may increase the infection risk because they retain bacteria and purulent wound exudate, create a hypoxic wound environment, and lead to less frequent wound monitoring. Given these concerns, hydrocolloid dressings are contraindicated for infected wounds. Use these dressing with care in diabetic patients. Make sure to obtain bacterial cultures before starting treatment, and change the dressing more often than in patients without diabetes. Also, because they’re occlusive, hydrocolloid dressings may lead to an overly moist wound environment, with excess moisture causing dressing separation and periwound maceration. Experts recommend using them only for wounds with low to moderate amounts of wound exudate. In addition, the hypoxic environment created by these dressings may delay and impede wound healing and raise the infection risk. Leukocytes phagocytize bacteria but can’t kill them in hypoxic environments because of the low oxygen tension; this significantly increases infection risk. Collagen maturation, endothelium development, keratinocyte migration, and granulation tissue formation depend on oxygen and may be inhibited by hypoxic wound bed conditions. (See Patient compliance factors.) More research needed Although many studies show hydrocolloid dressings are effective in treating diabetic foot ulcers, a 2012 systematic review by Dumville et al. found no evidence that they’re more effective than basic wound contact dressings. Also, according to a 2013 review of randomized controlled trials, hydrocolloid dressings aren’t more effective than basic wound contact dressings, foam dressings, alginate dressings, and topical treatments in managing diabetic foot ulcers. However, these studies produced sparse data and included research with risk of bias. Consequently, proper patient selection is crucial. We need further research to evaluate the safety and effectiveness of hydrocolloid dressings for diabetic foot ulcers and to establish further guidelines for their use. Kristine Hoffman practices podiatry at the Boulder Valley Foot and Ankle Clinic in Boulder, Colorado.http://woundcareadvisor.com/pros-and-cons-of-hydrocolloid-dressings-for-diabetic-foot-ulcers/http://woundcareadvisor.com/pros-and-cons-of-hydrocolloid-dressings-for-diabetic-foot-ulcers/
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http://www.practiceupdate.com/c/34230/1/4/?elsca1=emc_enews_expert-insight&elsca2=email&elsca3=practiceupdate_derma&elsca4=dermatology&elsca5=newsletter&rid=ODk3Nzg4MTg2NDIS1&lid=10332481 featured Published in Dermatology Journal Scan / Research · January 19, 2016 Statins May Be Associated With 6-Week Healing of Diabetic Foot Ulcers Wound Repair and Regeneration TAKE-HOME MESSAGE This multicenter, prospective observational study was designed to assess possible associations between diabetic foot ulcer (DFU) healing and use of medications (including statins, ACE inhibitors, alpha blockers, and beta blockers) assessed weekly while 139 patients were treated using standard care. While there was no significant association between the use of any of the tested medications and the primary outcome (6-week DFU wound size reduction), statins trended toward a positive association with improved DFU healing (P = .057). Statins have been thought to improve healing in mouse models and were associated with improved DFU healing in a previous smaller study. In this study, there was a nonsignificant trend to suggest that statins benefit DFU healing. – Sarah Churton, MD abstract This abstract is available on the publisher's site. Diabetic foot ulcers (DFUs) affect 1.5 million Americans annually, of which only a minority heal with standard care, and they commonly lead to amputation. To improve care, investigations are underway to better understand DFU pathogenesis and develop more effective therapies. Some currently used medications may improve healing. One small, randomized clinical trial found statins improve DFU healing. In this secondary analysis of a large multi-site prospective observational cohort of 139 patients with DFUs receiving standard care, we investigated whether there was an association between 6-week DFU wound size reduction and use of a variety of medications including alpha-blockers, beta-blockers, angiotensin converting enzyme inhibitors (ACEi) and statins. We found no significant (p<.05) association between six-week wound reduction and use of any of the evaluated drugs; however, statins did trend toward an association (p=0.057). This suggests a potential benefit of statins on DFU healing, and larger, targeted studies are warranted.
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http://www.practiceupdate.com/c/34373/1/8/?elsca1=emc_enews_expert-insight&elsca2=email&elsca3=practiceupdate_diab&elsca4=diabetes&elsca5=newsletter&rid=ODk3Nzg4MTg2NDIS1&lid=10332481 featured Published in Diabetes Journal Scan / Research · January 21, 2016 Association of Diabetic Foot Ulcer and Death Diabetic Medicine: A Journal of the British Diabetic Association TAKE-HOME MESSAGE The relationship between foot ulcers and mortality was examined in 414,523 patients with diabetes. After controlling for diabetes-associated complications, the researchers found a significant association, with a hazard ratio of 2.48, which they could not explain by other common risk factors. Foot ulcers in patients with diabetes are a major warning sign of mortality independent of the effect of other disease-associated complications. abstract This abstract is available on the publisher's site. AIMS The presence of diabetic foot ulcers is strongly associated with an increased risk of death. In this study, we investigate whether the effects of diabetes-associated complications can explain the apparent relationship between diabetic foot ulcers and death. METHODS We analysed data from 414 523 people with diabetes enrolled in practices associated with The Health Improvement Network in the United Kingdom. Our methods were designed to control for potential confounders in order to isolate the relationship between diabetic foot ulcers and death. Using proportional hazards models and the area under the receiver operator curve, we evaluated the effects of diabetic foot ulcers and the covariates on death. RESULTS Among the patients, 20 737 developed diabetic foot ulcers; 5.0% of people with new ulcers died within 12 months of their first foot ulcer visit and 42.2% of people with foot ulcers died within 5 years. After controlling for major known complications of diabetes that might influence mortality, the correlation between diabetic foot ulcers and death remained strong with a fully adjusted hazard ratio of 2.48 (95% confidence interval: 2.43, 2.54). Geographic variance existed but was not spatially associated. CONCLUSIONS Diabetic foot ulcers are linked to an increased risk of death. This cannot be explained by other common risk factors. These results suggest that either there are major unknown risk factors associated with both diabetic foot ulcers and death, or that diabetic foot ulceration itself is a serious threat, which seems unlikely. A diabetic foot ulcer should be seen as a major warning sign for mortality, necessitating closer medical follow-up.
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http://www.practiceupdate.com/c/34321/2/6/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_primary&elsca4=primary-care&elsca5=newsletter&rid=ODk3Nzg4MTg2NDIS1&lid=10332481 Published in Primary Care Journal Scan / Research · January 29, 2016 Individual Responses to a Barefoot Running Program The American Journal of Sports Medicine TAKE-HOME MESSAGE A cohort of 26 runners participated in an 8-week running program to gradually transition to barefoot running in a laboratory setting to assess the risk of injuries in the long term and the benefit achieved. Response was measured by change in barefoot initial loading rate, and 25% responded positively with a reduced initial loading rate. These people showed increased plantar flexion with increased biceps femoris and gluteus medius preactivation, as well as reduced rectus femoris muscle activity. No biomechanical changes were seen as a result of the intervention. Some participants responded negatively with a greater barefoot dorsiflexion on landing. Group biomechanics did not change as a result of an 8-week program of progressive barefoot running, but a subset of participants responded and showed specific beneficial changes in initial loading rate. abstract This abstract is available on the publisher's site. BACKGROUND Barefoot running is of popular interest because of its alleged benefits for runners, including reduced injury risk and increased economy of running. There is a dearth in understanding whether all runners can gain the proposed benefits of barefoot running and how barefoot running may affect long-term injury risk. PURPOSE/HYPOTHESIS The purpose of this study was to determine whether runners can achieve the proposed favorable kinematic changes and reduction in loading rate after a progressive training program that included barefoot running. It was hypothesized that not all individuals would experience a decrease in initial loading rate facilitated by increased ankle plantar flexion after a progressive barefoot running program; it was further hypothesized that relationships exist between changes in initial loading rate and sagittal ankle angle. STUDY DESIGN Descriptive laboratory study. METHODS A total of 26 habitually shod runners completed an 8-week, progressively introduced barefoot running program. Pre- and postintervention barefoot and shod kinematics, electromyography, and ground-reaction force data of the lower limb were collected. Ankle and knee kinematics and kinetics, initial loading rates, spatiotemporal variables, muscle activity during preactivation, and ground contact were assessed in both conditions before and after the intervention. Individual responses were analyzed by separating runners into nonresponders, negative responders, and positive responders based on no change, increase, and decrease in barefoot initial loading rate, respectively. RESULTS No biomechanical changes were found in the group after the intervention. However, condition differences did persist during both preactivation and ground contact. The positive-responder group had greater plantar flexion, increased biceps femoris and gluteus medius preactivation, and decreased rectus femoris muscle activity between testing periods. The negative responders landed in greater barefoot dorsiflexion after the intervention, and the nonresponders did not change. An overall change in ankle flexion angle was associated with a change in initial loading rate (r(2) = 0.345, P = .002) in the barefoot but not shod condition. CONCLUSION Eight weeks of progressive barefoot running did not change overall group biomechanics, but subgroups of responders (25% of the entire group) were identified who had specific changes that reduced the initial loading rate. It appears that changes in initial loading rate are explained by changes in ankle flexion angle at initial ground contact. CLINICAL RELEVANCE Uninstructed barefoot running training does not reduce initial loading rate in all runners transitioning from shod to barefoot conditions. Some factors have been identified that may assist sports medicine professionals in the evaluation and management of runners at risk of injury. Conscious instruction to runners may be required for them to acquire habitual barefoot running characteristics and to reduce risk of injury.
Neuropathic pain - MIMS Learning
http://www.mimslearning.co.uk/neuropathic-pain/activity/3343/?DCMP=EMC-mims_learning_update&spMailingID=13606407&spUserID=NTcwODk3MzkyNjQS1&spJobID=702061047&spReportId=NzAyMDYxMDQ3S0 MIMS Learning Topics CPD Organiser Resources Learning Plans Essentials Sign In 0 Overview Activity Post-Test Evaluation Claim Credit Neuropathic pain Neuropathic pain Format Knowledge Time to Complete 1 hour Published January 21, 2016 Updated January 21, 2016 Programme Description This activity covers neuropathic pain for GPs, as part of the Pain Patient Pathways series produced in partnership between GPonline, MIMS Learning and the British Pain Society. The five Pain Patient Pathways have been produced by the British Pain Society in collaboration with the Map of Medicine, and they cover pain assessment, low back pain, neuropathic pain, chronic widespread pain and chronic pelvic pain. Educational Objectives Understand how neuropathic pain presents Conduct a thorough initial assessment Prescribe recommended pharmacological therapy Provide appropriate review and follow-up
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http://www.practiceupdate.com/c/34373/1/8/?elsca1=emc_enews_expert-insight&elsca2=email&elsca3=practiceupdate_diab&elsca4=diabetes&elsca5=newsletter&rid=ODk3Nzg4MTg2NDIS1&lid=10332481 featured Published in Diabetes Journal Scan / Research · January 21, 2016 Association of Diabetic Foot Ulcer and Death Diabetic Medicine: A Journal of the British Diabetic Association TAKE-HOME MESSAGE The relationship between foot ulcers and mortality was examined in 414,523 patients with diabetes. After controlling for diabetes-associated complications, the researchers found a significant association, with a hazard ratio of 2.48, which they could not explain by other common risk factors. Foot ulcers in patients with diabetes are a major warning sign of mortality independent of the effect of other disease-associated complications.
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http://www.practiceupdate.com/c/34335/2/8/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_diab&elsca4=diabetes&elsca5=newsletter&rid=ODk3Nzg4MTg2NDIS1&lid=10332481 Published in Diabetes Journal Scan / Research · January 20, 2016 Nutritional Status and Outcomes of Diabetic Foot Ulcers Journal of Diabetes and Its Complications TAKE-HOME MESSAGE The effect of nutritional status on outcomes of foot ulcers was studied in 478 patients with diabetes. Lower nutritional status scores were significantly associated with increased likelihood of requiring a lower-extremity amputation; decreasing nutritional scores were also associated with increasingly severe lower-extremity amputations. Poor nutritional status appears to be a risk factor for amputation in diabetic patients with foot ulcers.
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