Evidence-Based Opioid Education That Reduces Prescribing: The 10 Principles of Opioid Prescribing in Foot and Ankle Surgery.

Over half of opioid misusers last obtained access to opioids via a friend or relative, a problematic reflection of the opioid reservoir phenomenon, which results from an unused backlog of excess prescription opioids that are typically stored in the American home. We aim to determine if a voluntary educational intervention containing standard opioid and nonopioid analgesic prescribing ranges for common surgeries is effective in altering postoperative prescribing practice. We utilized a mixed methods approach and sent out a questionnaire to American podiatric physicians, including residents (baseline group A), via email in early 2020 for baseline data; then, we interviewed foot and ankle surgeons and the primary themes of these semistructured interviews informed us to target residents for an educational intervention.

The Development and Usability of the AMPREDICT Decision Support Tool: A Mixed Methods Study.

Objective: Amputation level decision making in patients with chronic limb threatening ischaemia is challenging. Currently, evidence relies on published average population risks rather than individual patient risks. The result is significant variation in the distribution of amputation levels across health systems, geographical regions, and time.

Characteristics of High-Functioning Collaborations Between Primary Care and Podiatry in VHA Patient Aligned Care Teams.

The key to high-functioning PACT/Podiatry teams rests with the quality of the communication between providers.

Evidence-Based Approach to Advanced Wound Care Products.

There is increasing pressure from industry to use advanced wound care products and technologies. Many are very expensive but promise to reduce overall costs associated with wound care. Compelling anecdotal evidence is provided that inevitably shows wounds that failed all other treatments but responded positively to the subject product.

Parents' perception of child and adolescent mental health problems and their choice of treatment option in southwest Ethiopia.

Background: Parents' perception and awareness about psychiatric illness in children and adolescents is an important determinant of early detection and treatment seeking for the condition. However, there has been limited information about the perception and awareness of parents about these issues as well as their preferred treatment options in Ethiopia. This study is, therefore, aimed at assessing the perception of parents about psychiatric illness in children and adolescents and their preferred treatment options in Jimma, Ethiopia.

The system of care for the diabetic foot: objectives, outcomes, and opportunities.

Most cases of lower extremity limb loss in the United States occur among people with diabetes who have a diabetic foot ulcer (DFU). These DFUs and the associated limb loss that may occur lead to excess healthcare costs and have a large negative impact on mobility, psychosocial well-being, and quality of life. The strategies for DFU prevention and management are evolving, but the implementation of these prevention and management strategies remains challenging.

History of the team approach to amputation prevention: pioneers and milestones.

This historical perspective highlights some of the pioneers, milestones, teams, and system changes that have had a major impact on management of the diabetic foot during the past 100 years. In 1934, American diabetologist Elliott P. Joslin noted that mortality from diabetic coma had fallen from 60% to 5% after the introduction of insulin, yet deaths from diabetic gangrene of the lower extremity had risen significantly.

History of the team approach to amputation prevention: pioneers and milestones.

Background: This historical perspective highlights some of the pioneers, milestones, teams, and system changes that have had a major impact on the management of the diabetic foot during the past 100 years. In 1934, American diabetologist Elliott P. Joslin noted that mortality from diabetic coma had fallen from 60% to 5% after the introduction of insulin, yet deaths from diabetic gangrene of the lower extremity had risen significantly.

Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration?

Five-year mortality rates after new-onset diabetic ulceration have been reported between 43% and 55% and up to 74% for patients with lower-extremity amputation. These rates are higher than those for several types of cancer including prostate, breast, colon, and Hodgkin's disease. These alarmingly high 5-year mortality rates should be addressed more aggressively by patients and providers alike.

Reducing the rate of amputations in acute diabetic foot infections.

Many older diabetic patients present to the emergency room with limb-threatening foot complications, and may at the same time need attention to life-threatening endocrine, cardiac, or renal complications. To better serve the elderly veteran population at our institution, we designed a multidisciplinary, algorithmic approach that links the podiatry and medicine services to facilitate appropriate referral, admission, and management, with the ultimate goal of reducing the rate of amputations.

Diabetes-related foot care at 10 Veterans Affairs medical centers: must do's associated with successful microsystems.

Background: Well-coordinated interdisciplinary preventive foot care has been reported to significantly reduce diabetes-related foot ulcers, amputations, and hospitalization. However, the contribution of the specific components leading to these "successes" is not fully characterized. The microsystem conceptual framework was adapted to foot care to determine which of the microsystem success characteristics were associated with decreased major lower-limb amputation rates at 10 Veterans Affairs (VA) medical centers.

Impact of policies and performance measurement on development of organizational coordinating strategies for chronic care delivery.

Objective: To examine the impact of policy directives and performance feedback on the organization (specifically the coordination) of foot care programs for veterans, as mandated by public law within the Department of Veterans Affairs Health Care System (VA).

Study Design: Case study of 10 VA medical centers performing diabetes-related amputations.

Patients And Methods: Based on expert consensus, we identified 16 recommended foot care delivery coordination strategies.

The relationship between provider coordination and diabetes-related foot outcomes.

Objective: To investigate the relationship between provider coordination and amputations in patients with diabetes.

Research Design And Methods: The study design was a cross-sectional, descriptive study of process and outcomes for diabetes-related foot care at 10 Department of Veterans Affairs (VA) medical centers representing different geographic regions, population densities, patient populations, and amputation rates. The subjects included all providers of diabetes foot care and a random sample of primary care providers at each medical center.

Treatment of onychomycosis in the diabetic patient population.

Onychomycosis is a common medical condition in patients with diabetes. Conflicting data exist as to whether diabetes predisposes patients to the disease. Controversy notwithstanding, patients with diabetes have several medical conditions (obesity, peripheral neuropathy, and retinopathy) that can inhibit the identification or mask the progression of fungal nail infections.