Please read the abstract in the section 00front of this document / Thesis (PhD (Microbiology))--University of Pretoria, 2007. / Microbiology and Plant Pathology / unrestricted

Abstract Development of Assessment and Screening Tool to Assist with Prevention and Identification of Charcot Foot in Type 2 Diabetics by Louise Wade MSN, RN MS, West Texas A&M University, 2010 BS, West Texas A&M University, 2010 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 Abstract According to the World Health Organization, up to 50% of type 2 diabetic patients develop neuropathy, which may cause major infections, amputation, and Charcot foot due to impaired sensation. Early recognition and care is essential for treatment of Charcot foot and prevention of further injury. Due to the complexity of this potentially life threatening complication, assessment is challenging, especially when practitioners who treat adult diabetic patients may not be familiar with Charcot foot. The purpose of this scholarly project was to develop an assessment, screening tool, and algorithm for detecting Charcot foot; an additional goal was to develop practice guidelines for practitioners to assist in the early recognition, treatment, and referral of adult diabetic patients at risk for Charcot foot. Lippitt's theory of change was used to guide the project. An interdisciplinary team of stakeholders was assembled to guide development of the tool, algorithm, and practice guidelines. Products were developed in accordance with evidence in current peer-reviewed literature and American Diabetes Association recommendations for Charcot foot diagnosis, treatment, and referral. Content was validated using a scale content validation instrument process to obtain input from experts in the care of Charcot foot. An implementation plan was developed to guide introduction of the products into practice, and an evaluation plan created to determine the extent to which intermediate term outcomes are met using these products. The project may contribute to social change by identifying patients at risk for Charcot foot prior to the onset of the complication, therefore preventing further injury, deformity, or amputation in populations that are often unable to afford quality healthcare.

No description available.

Diabetic foot ulcers (DFUs) impart a large burden on patients and the healthcare system in Canada. Health utility estimates are an integral part of determining the cost-effectiveness of treatments for DFUs. The objective of this thesis was to identify health utility estimates for patients with non-healing DFUs. A systematic review of studies reporting health utility estimates for non-healing DFUs was conducted and included nine studies. The quality of the studies, as it related to the health utility estimates for non-healing DFUs, was difficult to determine due to a lack of reporting of study and patient characteristics. The health utility estimates ranged from 0.44 to 0.89. None of the studies investigated for factors associated with the health utility of patients with non-healing DFUs. In addition, an exploratory regression analysis of data from a randomized controlled trial (RCT) of hyperbaric oxygen therapy (HBOT) in patients with chronic, non-healing DFUs was conducted. No factors were identified that were associated with health utility; however, the sample size was small and the analysis exploratory. Further research is required to identify such factors. Finally, a descriptive regression model, including several baseline factors, was created which provided a heath utility estimate of 0.647 for Canadian patients with non-healing DFUs; however, the results should be interpreted with caution, especially as some subgroups had very small numbers of patients (e.g., Wagner Grade of 4; patients with 4 or more wounds). In summary, guidance is lacking on the best methodology to conduct and analyze studies that provide estimates of the health utility of patients with non-healing DFUs, or any other health state, that are to be used to inform economic evaluations. Additionally, a tool is needed to aid analysts in critically appraising studies so that they can select the best estimate of health utility value to include in economic evaluations. / Thesis / Master of Health Sciences (MSc) / Diabetic foot ulcers (DFUs) impart a large burden on patients and the healthcare system in Canada. The objective of this thesis was to identify health utility estimates for patients with non-healing DFUs. A systematic review was conducted and included nine studies, for which health utility estimates ranged from 0.44 to 0.89. An exploratory regression analysis of data from an Ontario-based study in patients with non-healing DFUs was conducted. No factors associated with health utility were identified but further research is required. A descriptive regression model, adjusting for several baseline factors, provides a health utility of 0.647 for Canadian patients, but should be interpreted with caution. Guidance is needed on the best methodology to conduct studies to estimate the health utilities for use in economic evaluations and for a tool to critically appraise studies to help select the best estimate of health utility for inclusion in economic evaluations.

Although medical practice guidelines for diabetic foot care exist globally, there is no clear guideline for nurses to direct clinical foot care practices for diabetic patients in Thailand. The purposes of this qualitative study were to explore the current practice of diabetic foot care and to develop a nursing practice guideline for effective foot care. The research design included two phases, consisting of situation exploration and practice guideline development. For the first phase, semi structured interviews were conducted among fifteen diabetic patients, five nurses, and five nurse educators at Prapokklao hospital, Thailand to discover their knowledge and practice in foot care. A content analysis approach was used in data analysis. The findings revealed that, although foot care education was available, diabetic patients lacked knowledge and had poor foot self-care practice. Nurses and educators also had inadequate knowledge about effective diabetic foot care and they had scarcely ever provided advanced practice for foot care. Moreover, patients had not been categorised regarding their foot risk level, nor had they received appropriate levels of foot care to manage their particular situations. For the second phase, a nursing practice guideline was developed. The classical Delphi technique was applied to examine experts’ agreement on the practice guideline contents. A questionnaire was developed, based on the first phase’s information and critical literature review using Soukup’s model. Twenty diabetic foot care experts from around Thailand completed the questionnaire. The acceptance of experts’ agreement was 94-100% in all aspects. A final guideline was developed which consisted of the initial risk assessment of foot ulceration and specific guidance on the interventions. This guideline, based upon local specialist expert opinion, provides a clear resource for referral and standardised procedures for evaluating footwear and screening to detect the risk of foot complications. In conclusion, this current nursing practice guideline for diabetic foot care was the first guideline for Thai nurses to care for diabetic patients in a Thai cultural context, and is based on local specialist experts’ opinion. This foundation work provides the basis for further research and evaluation concerning the prevention of foot complications and foot management for diabetic patients, including evaluating the effectiveness of the current risk assessment form and risk classification procedures.

Although the vertical jump has long been an accepted and valuable test of explosive strength and physical ability, the major factors affecting performance have not been isolated. This study was designed to investigate vertical-jump performance in relation to certain foot measurements. Two ratios comprised of heel/foot length and arch length/foot length were correlated to vertical-jump performance.

This thesis was written with two purposes: first, to consider the practice of foot-washing as a sacrament/al; and, second, to apply what was learned in order to appropriate the practice of foot-washing for contemporary worship services. Several methodologies advanced the work. A theological approach enabled a comparison of the definitions of “sacrament,” “sacramental,” and “sacramentality,” which led to a demonstration of foot-washing as a “sacramental” insofar as it has the capacity to reveal the divine and possibly to be a means of grace. Historical and socio-contextual approaches undergirded the examination of three Christian traditions that regarded foot-washing as a sacrament or sacramental: the Johannine community of John 13; Ambrose of Milan’s community and its post-baptismal practice; and the Mennonites. With the tools of liturgical analysis, examination was made of foot-washing as it appears in liturgical texts for several current Christian denominations in the United States and Korea. The themes inherent in these newer uses of foot-washing were compared with those of the three historical Christian traditions. The research disclosed that, in terms of contemporary usage, foot-washing is primarily located in rites for Maundy Thursday, while marginalized or absent in other worship contexts. This limitation called for the development of a “sacramental” foot-washing rite for ordinary worship services. The proposed foot-washing rite not only provides an opportunity to meditate on Jesus’ death and sacrificial love in connection with the Triduum, but also accentuates themes such as Jesus’ humility, God’s reconciliation with humanity, forgiveness of sin, and the consolidation of the church community.

Introduction: Gout affects approximately 15% of Maori and Pacific men, these men being at risk of early onset, severe disease with formation of gouty tophi and joint damage. Gout most frequently affects the foot, particularly the big toe and midfoot. This disease initially presents as self-limiting attacks of severe joint inflammation, and in the presence of persistent hyperuricaemia, tophaceous disease may also develop. Tophi are collections of monosodium urate crystals surrounded by chronic inflammatory cells and connective tissue. Tophi typically occur in both subcutaneous tissues and within affected joints, and may cause pain, cosmetic problems, mechanical obstruction of joint movement, and joint destruction. Despite the predilection of gout to the foot, the impact of gout on foot function is currently unknown and only case studies relating to hallux pain, tibial sesamoid pain and longitudinal tears in peroneal tendons have been reported in the literature. The aim of this study is to assess the intra-tester reliability of certain biomechanical tests to evaluate foot structure and function (plantar pressure measurements, gait parameters, range of motion at the ankle and first MTPJ and the foot posture index) in individuals with gout and to assess the differences between disability, impairment, foot structure and function between individuals with gout and non-gout controls. Subjects: A total of 25 patients with chronic gout with a mean age of 61.2 (11.7) years old were recruited from a rheumatology clinic within the Auckland District Health Board. A further 25 age-and sex-matched controls with a mean age of 57.3 (12.2) years old were recruited from AUT University. Methods: Disability, impairment, foot structure and foot function were assessed for the gout and the control group. Disability and impairment was assessed using the Health Assessment Questionnaire, Foot Function Index, Leeds Foot Impact Scale and Lower Limb Task Questionnaire. Foot structure was investigated using the Foot Posture Index, first metatarsophangeal joint (MTPJ) dorsiflexion, ankle dorsiflexion movement, subtalar joint and midtarsal joint motion, Foot Problem Score, tophi count and muscle strength of extrinsic and intrinsic foot muscles. Foot function was investigated using an in-shoe pressure system measuring mean peak plantar pressures and pressure-time integrals. Temporal-spatial gait parameters were evaluated, as well as peripheral sensation and vibration perception threshold. Plantar pressures were assessed using the Tekscan pressure insole system, gait parameters were measured using the Gaitmat walkway system, peripheral sensation and vibration threshold were assessed using 10gm monofilament and biothesiometer respectively. Intra-tester reliability was investigated using ICC, Standard Error of Measurement and Smallest Real Difference in the gout group for key measures (Foot Posture Index, first MTPJ dorsiflexion, ankle dorsiflexion movement, peak plantar pressures, pressure-time integrals and gait parameters). To investigate the significant difference between the groups, the left and right foot in gout were compared with the left foot of the control group using ANOVA with post-hoc comparisons. Non-parametric tests were used for muscle strength, peripheral sensation and Foot Problem Score and motion at the subtalar and midtarsal joints for comparison between the groups. Walking velocity, cadence and disability and impairment scores between the groups were assessed using an independent t-test with 95% confidence intervals. Significance for all these measures was set to 0.05 except for Chi square where a significance of 0.02 was set. Results: The ICC for the intra-tester reliability was excellent with low measurement error for the measured outcomes. The gout group recorded significantly higher disability and impairment scores than controls (p<0.01). Significant differences between the two groups were recorded for vibration pressure threshold, muscle strength, Foot Problem Score, first MTPJ dorsiflexion, foot motion and gait parameters (p<0.05). Significant differences were demonstrated under the toes for mean plantar pressures and under the lateral heel, midfoot and hallux regions for pressure-time integrals in the gout cases (p<0.05). Conclusions: Individuals with gout have reduced quality of life due to greater disability and impairment. The gouty foot is slightly supinated with reduced dorsiflexion at the first MTPJ. Rearfoot and forefoot motions are limited with a high incidence of digital deformities and dermatological lesions. The foot function in gout is characterized by reduced walking velocity, cadence, step and stride length. The plantar pressures are reduced under the toes with increased duration of loading under the hallux, lateral heel and midfoot regions. Further research using three-dimensional gait analysis is recommended to quantify motion at the foot and ankle joints and also to ascertain the role of proximal joints. Future work could be undertaken to evaluate the impact of acute gout on objective measures of foot function, and to determine predictors of poor foot function in patients with this disease. This will allow further work to investigate or formulate a podiatric management plan in conjunction with pharmacological therapy to improve impairment, disability and function in chronic gout.

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2004. / Includes bibliographical references (leaves 132-135). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Diabetes is a condition that can lead to foot ulcers that often progress to amputation of a limb. Providing patients with education about foot care is crucial because it can help to prevent or minimize the incidence of foot ulcer development and amputation of a limb. Foot care education as a strategy not only empowers patients with proper foot care knowledge and skill to support and motivate self-care but can also enhance the partnership between the provider and patient. The purpose of this quality improvement project was the implementation of a sustainable evidence-based foot care program for adult patients with diabetes as a routine organizational protocol for quality improvement in diabetic care in a primary care clinic. The question for this project was: How does the implementation of an evidence-based diabetic foot care protocol impact the health outcomes of diabetic patients in a primary care clinic? Orem’s self-care deficit nursing theory and the logic model for evidence-based practice were used to guide this DNP project. The research method for the quality improvement project was a review of the literature. The participants were staff and adults with diabetes at the primary care clinic. The results of the chart review showed that 80% of the charts included documented foot assessments and patient education, which was an improvement when compared to 40% pre-implementation of the foot care program. The program has improved the foot health knowledge and skills of clinicians and people with diabetes and has also helped to reduce the burden of healthcare costs related to the lower incidence of hospitalization for the treatment of wounds and amputation associated with complications of diabetes.