scholarly journals 326. More Specialties, Less Problems: Creating collaborative competency between Infectious Disease, Podiatry, and Pathology co-managing diabetic foot infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S235-S235
Author(s):  
Vimal V Jhaveri ◽  
Chrsitopher Sullivan ◽  
Ashley Ward ◽  
John Giurini ◽  
Adolf W Karchmer ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Diabetic Foot ◽  
Cochrane Review ◽  
Foot Ulcer ◽  
The United States ◽  
Medical Problem ◽  
Knowledge Gain ◽  
Oral Antibiotics ◽  
Educational Session ◽  
Diabetic Foot Osteomyelitis

Abstract Background According to the 2016 and 2017 National Health Interview Survey, 9.7% of the US population is estimated to have diabetes mellitus (either type 1 or type 2). 1 Among patients with diabetes, there is a 15% lifetime risk of developing a foot ulcer, making it an extremely common medical problem seen in both outpatient and inpatient settings.2 In fact, Medicare spends $9–13 billion/year on diabetic foot osteomyelitis (DFO).3 Despite this high prevalence and cost, experts have not agreed on a set of diagnostic criteria for diagnosing DFO, 4 nor the optimal antibiotic management.5 For example, while traditionally diabetic foot osteomyelitis has been treated with 4–6 weeks of IV antibiotics in the United States, oral antibiotics have been shown to be effective with similar cure rates in multiple studies 6–8, non-inferior in a Cochrane review,5 and are recommended in the most recent (2012) Infectious Disease Society of America (IDSA) DFO clinical practice guidelines.9 Methods Representatives from ID, Podiatry, and Pathology collaborated to develop consensus on aspects of management of DFO. We created an educational session, inviting providers from all three departments to develop consensus on some of the controversial aspects of DFO. We assessed for knowledge gain by having these providers complete a pre-test survey as well as a post-test survey 2 weeks after the intervention. Results 27 providers completed both a pre and post-tests after attending the educational session. Significant improvements were observed in learners understanding of duration of antibiotic treatment and the role of oral antibiotics in certain cases of diabetic foot osteomyelitis to obviate the need for an unnecessary intravenous antibiotics and Peripherally Inserted Central Catheter (PICC) lines. Additionally, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality and efficiency of care provided to these patients. Figure 1: Results of the Pre- and Post- Assessment Conclusion This multidisciplinary, educational session regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments. Further study is being completed assessing patient outcomes before and after this intervention and will be available by IDWeek. Disclosures All Authors: No reported disclosures

Treatment of Diabetic Foot

2018 ◽  
Author(s):  
Anil Hingorani
Keyword(s):  
Internal Medicine ◽  
Infectious Disease ◽  
Intensive Care ◽  
Diabetic Foot ◽  
Multidisciplinary Approach ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Acute Care Surgery ◽  
Surgical Practice ◽  
Care Surgery

The diabetic foot is a commonly encountered problem in surgical practice. Since treatment of the diabetic foot is quite complex, its management can mandate a multidisciplinary approach, including vascular surgery, acute care surgery, intensive care, podiatry, internal medicine, endocrinology, infectious disease, nursing, case management, and social work. This review highlights some of the details of the management of the diabetic foot from such an approach. This review contains 1 figure and 21 referencesKey words: diabetic foot ulcer, infection, ischemia, off-loading, revascularization

Treatment of Diabetic Foot

2018 ◽  
Author(s):  
Anil Hingorani
Keyword(s):  
Internal Medicine ◽  
Infectious Disease ◽  
Intensive Care ◽  
Diabetic Foot ◽  
Multidisciplinary Approach ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Acute Care Surgery ◽  
Surgical Practice ◽  
Care Surgery

The diabetic foot is a commonly encountered problem in surgical practice. Since treatment of the diabetic foot is quite complex, its management can mandate a multidisciplinary approach, including vascular surgery, acute care surgery, intensive care, podiatry, internal medicine, endocrinology, infectious disease, nursing, case management, and social work. This review highlights some of the details of the management of the diabetic foot from such an approach. This review contains 1 figure and 21 referencesKey words: diabetic foot ulcer, infection, ischemia, off-loading, revascularization

Diagnosis of Diabetic Foot

2018 ◽  
Author(s):  
Anil Hingorani
Keyword(s):  
Internal Medicine ◽  
Infectious Disease ◽  
Intensive Care ◽  
Diabetic Foot ◽  
Multidisciplinary Approach ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Acute Care Surgery ◽  
Surgical Practice ◽  
Care Surgery

The diabetic foot is a commonly encountered problem in surgical practice. Since treatment of the diabetic foot is quite complex, its management can mandate a multidisciplinary approach, including vascular surgery, acute care surgery, intensive care, podiatry, internal medicine, endocrinology, infectious disease, nursing, case management, and social work. This review highlights some of the details of the diagnosis of the diabetic foot from such an approach.   This review contains 10 figures and 30 references Key words: diabetic foot ulcer, infection, ischemia, off-loading, revascularization  

Diagnosis of Diabetic Foot

2018 ◽  
Author(s):  
Anil Hingorani
Keyword(s):  
Internal Medicine ◽  
Infectious Disease ◽  
Intensive Care ◽  
Diabetic Foot ◽  
Multidisciplinary Approach ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Acute Care Surgery ◽  
Surgical Practice ◽  
Care Surgery

The diabetic foot is a commonly encountered problem in surgical practice. Since treatment of the diabetic foot is quite complex, its management can mandate a multidisciplinary approach, including vascular surgery, acute care surgery, intensive care, podiatry, internal medicine, endocrinology, infectious disease, nursing, case management, and social work. This review highlights some of the details of the diagnosis of the diabetic foot from such an approach.   This review contains 10 figures and 30 references Key words: diabetic foot ulcer, infection, ischemia, off-loading, revascularization  

Vaccine Court

2016 ◽  
Author(s):  
Anna Kirkland
Keyword(s):  
Infectious Disease ◽  
United States ◽  
Disease Control ◽  
Crucial Role ◽  
The United States ◽  
Medical Problem ◽  
Primary Sources ◽  
Infectious Disease Control ◽  
Fault Compensation ◽  
Compensation Program

In Vaccine Court, Anna Kirkland tells the story of how a special no-fault compensation court in the United States handles very controversial claims that a vaccine has harmed someone. Vaccines are an important part of infectious disease control in our society and also touch us in very personal ways. While vaccines overall are extremely safe and effective, some people still suffer severe vaccine reactions and bring their claims to vaccine court. In this court, lawyers, activists, judges, doctors, and scientists come together, sometimes arguing bitterly, to determine whether a vaccine truly caused a person’s medical problem. Vaccine Court draws on the court rulings, observations at the court, and previously unstudied primary sources spanning the thirty years of the Vaccine Injury Compensation Program to ask how we know a vaccine injury. Despite all the controversy swirling around vaccines, this special court provides a place for reasoned argument and consideration of a range of evidence and perspectives that ultimately support the crucial role vaccines play in our society while also doing justice to people who have been harmed.

scholarly journals More Specialties, Less Problems: Using collaborative competency between Infectious Disease, Podiatry, and Pathology to improve the care of patients with diabetic foot osteomyelitis

2021 ◽  
Author(s):  
Vimal V Jhaveri ◽  
Christopher Sullivan ◽  
Ashley Ward ◽  
John Giurini ◽  
A. W. Karchmer ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Diabetic Foot ◽  
Post Intervention ◽  
Clinical Endpoints ◽  
Intravenous Antibiotics ◽  
Provider Knowledge ◽  
Pathology Reports ◽  
Definition Of ◽  
Diabetic Foot Osteomyelitis

BACKGROUND: Diabetic Foot Osteomyelitis (DFO) is a common infection where treatment involves multiple services including Infectious Disease (ID), Podiatry, and Pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking. METHODS: Representatives from ID, Podiatry, and Pathology interested in quality improvement (QI) developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to DFO. Knowledge acquisition was assessed by pre- and post-intervention surveys. Inpatients with forefoot DFO were retrospectively reviewed pre- and post- intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses. RESULTS: A post-intervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the pre-intervention cohort (4/1/2018-4/1/2019) and 32 patients in the post-intervention cohort (11/5/2019-03/01/2020), the latter truncated by changes in hospital practice during the COVID-19 pandemic. Non-categorizable or equivocal pathology reports decreased from pre-intervention to post-intervention (27.0% vs 3.3%, respectively, P=0.006). We observed non-significant improvement in correct bone margin definition (74.0% vs 87.5%, p=0.11), unnecessary PICC line placement (18.3% vs 9.4%, p=0.23), and unnecessary prolonged antibiotics (21.9% vs 5.0%, p=0.10). Additionally, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients. CONCLUSIONS: This QI initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and non-significant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions.

scholarly journals A multicenter randomized placebo controlled trial of rifampin to reduce pedal amputations for osteomyelitis in veterans with diabetes (VA INTREPID)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mary T. Bessesen ◽  
Gheorghe Doros ◽  
Adam M. Henrie ◽  
Kelly M. Harrington ◽  
John A. Hermos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Antimicrobial Therapy ◽  
Diabetic Foot ◽  
Adjunctive Therapy ◽  
The United States ◽  
Quality Data ◽  
Free Survival ◽  
Primary Hypothesis ◽  
Diabetic Foot Osteomyelitis

Abstract Background The prevalence of diabetes mellitus continues to inexorably rise in the United States and throughout the world. Lower limb amputations are a devastating comorbid complication of diabetes mellitus. Osteomyelitis increases the risk of amputation fourfold and commonly presages death. Antimicrobial therapy for diabetic foot osteomyelitis (DFO) varies greatly, indicating that high quality data are needed to inform clinical decision making. Several small trials have indicated that the addition of rifampin to backbone antimicrobial regimens for osteomyelitis outside the setting of the diabetic foot results in 28 to 42% higher cure rates. Methods/design This is a prospective, randomized, double-blind investigation of the addition of 6 weeks of rifampin, 600 mg daily, vs. matched placebo (riboflavin) to standard-of-care, backbone antimicrobial therapy for DFO. The study population are patients enrolled in Veteran Health Administration (VHA), ages ≥18 and ≤ 89 years with diabetes mellitus and definite or probable osteomyelitis of the foot for whom an extended course of oral or intravenous antibiotics is planned. The primary endpoint is amputation-free survival. The primary hypothesis is that using rifampin as adjunctive therapy will lower the hazard rate compared with the group that does not use rifampin as adjunctive therapy. The primary hypothesis will be tested by means of a two-sided log-rank test with a 5% significance level. The test has 90% power to detect a hazard ratio of 0.67 or lower with a total of 880 study participants followed on average for 1.8 years. Discussion VA INTREPID will test if a rifampin-adjunctive antibiotic regimen increases amputation-free survival in patients seeking care in the VHA with DFO. A positive finding and its adoption by clinicians would reduce lower extremity amputations and their associated physical and emotional impact and reduce mortality for Veterans and for the general population with diabetic foot osteomyelitis. Given that rifampin-adjunctive regimens are currently employed for therapy for the majority of DFO cases in Europe, and only in a small minority of cases in the United States, the trial results will impact therapeutic decisions, even if the null hypothesis is not rejected. Trial registration Registered January 6, 2017 at ClinicalTrials.gov, NCT03012529.

Diagnosis of Diabetic Foot

2018 ◽  
Author(s):  
Anil Hingorani
Keyword(s):  
Internal Medicine ◽  
Infectious Disease ◽  
Intensive Care ◽  
Diabetic Foot ◽  
Multidisciplinary Approach ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Acute Care Surgery ◽  
Surgical Practice ◽  
Care Surgery

The diabetic foot is a commonly encountered problem in surgical practice. Since treatment of the diabetic foot is quite complex, its management can mandate a multidisciplinary approach, including vascular surgery, acute care surgery, intensive care, podiatry, internal medicine, endocrinology, infectious disease, nursing, case management, and social work. This review highlights some of the details of the diagnosis of the diabetic foot from such an approach.   This review contains 10 figures and 30 references Key words: diabetic foot ulcer, infection, ischemia, off-loading, revascularization  

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