Mariam Botros

Diabetic foot ulcers: Part II. Management.

The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality.

Best practices for the management of foot ulcers in people with diabetes.

Care of people with diabetic foot ulcers requires a systematic approach following the wound bed preparation paradigm and the existing best practice recommendations. The purpose of this article is to summarize key evidence and recommendations regarding prevention and management of diabetic foot ulcers that can be translated into practice.

Saving diabetic limbs in Canada: partnership between the Public Health Agency of Canada and the Canadian Association of Wound Care.

INTRODUCTION Diabetes is a complex multi-system disease (1). The World Health Organization projects diabetes to increase from 171 million in 2000 to 366 million in 2030 with most increases occurring in Third-World countries and Aboriginal populations (2). In Canada, in 2008/2009, 200 000 new cases of diabetes were diagnosed; 47.5% of these individuals were obese (3). The correlation of diabetes to obesity is significant, and there is a direct relationship between dietary and lifestyle choices, food intake and activity levels with rates of diabetes (3,4). With these increasing rates we need to be prepared to support persons with diabetes with prevention strategies and self-management support. In Canada, Type 1 and Type 2 diabetes rates are dramatically increasing in direct proportion to obesity rates and the aging population (3). In 2003, the Institute for Clinical Evaluative Sciences reported that 2 million Canadians have diabetes with a yearly estimated cost of

Toenail Onychomycosis—A Canadian Approach With a New Transungual Treatment Development of a Clinical Pathway

9 billion annually (5). The Public Health Agency of Canada (PHAC) (3) reports an even higher rate of diabetes at 2.4 million of the 34 million Canadians (6).

Role of a point-of-care protease activity diagnostic test in Canadian clinical practice: a Canadian expert consensus ©.

Background: Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy. Objective: To define a patient-centred Canadian treatment strategy for onychomycosis. Methods: An expert panel of doctors who treat onychomycosis was convened. A systematic review of the literature on treatments for onychomycosis was conducted. Based on the results, a survey was designed to determine a consensus treatment system. Results: First-line therapy should be selected based on nail plate involvement, with terbinafine for severe onychomycosis (>60% involvement), terbinafine or efinaconazole for moderate onychomycosis (20%-60% involvement), and efinaconazole for mild onychomycosis (<20% involvement). Comorbidities, patient preference and adherence, or nail thickness may result in the use of alternative oral or topical antifungals. Conclusion: These guidelines allow healthcare providers and patients to make informed choices about preventing and treating onychomycosis.

Is leg pain a significant contributor to health care budget pain

ABSTRACT Nonhealing wounds (stalled, healable) challenge affected individuals, wound clinicians, and society. Nonhealing may result despite local factors being corrected. The interplay between tissue degradation, increased inflammatory response, and abundant protease activity is a challenging quandary. A modified Delphi process was utilized to investigate a protease activity test and practice implications.

Diabetic foot ulcers: Part I. Pathophysiology and prevention

Peripheral arterial disease (PAD) has major impact on leg function, and the most common symptom of PAD is the exertional leg muscle fatigue, cramping or pain known as ‘claudication’. Lack of leg blood flow, thus, is associated with disability and a poor quality of life. When PAD is not promptly diagnosed and treated and leg blood flow is severely decreased, it may lead to ‘critical limb ischaemia’ and amputation. PAD is also a warning sign that other arteries in the body, including those in the heart and brain, may also be blocked. Thus, it is also associated with a high risk of heart attack, stroke and even death. These are significant health care issues and it has been shown that an insufficient arterial blood flow can impede wound healing, making it almost impossible to heal wounds with any treatment. Two out of three patients are not aware of PAD, a common vascular disease that affects as many as 28 000 000 people in the G7 countries alone, 50% of which are asymptomatic. Patients with chronic diabetes or advanced vascular disease can develop pain in their legs as a consequence of the underlying disease. PAD is a term used to describe diseased blood vessels that are not related to the heart. It results from a build-up of plaque in the walls of blood vessels (arteries). This reduces or blocks the flow of blood to the legs and other organs. PAD is most commonly seen in the legs. If untreated this can lead to major amputations and even when treated around 40% of patients will need an amputation. Amputations are expensive both to the health care system and also society, as these patients become less productive members of society. Treatment costs are not insignificant but are certainly less expensive than the costs associated with ongoing leg pain or amputation. Once diagnosed there are three main approaches to treating PAD: lifestyle changes, medication and in some cases endovascular procedures or surgery. A health care provider will determine the best treatment option in partnership with the patient based on his or her symptoms, life circumstances and medical history. PAD prevalence is increasing globally, fuelled by increasing rates of obesity and diabetes. The condition affects around 28 million individuals in the G7 (Table 1), however, at present the majority of PAD patients remain undiagnosed and untreated. PAD is often under-diagnosed because awareness of the disease is low both within the public and the general medical community. The medical products industry and specialist health care societies in many of the G7 countries are heavily invested in health care education and public awareness programmes, as a way to increase disease awareness and to promote earlier detection. Table 1 Prevalence of PAD, total and diagnosed, by country 2011–2014*