Fear Of Amputation Research Articles

PENGARUH EDUKASI PERKEMBANGAN LUKA BERBASIS FOTO TERHADAP KECEMASAN PASIEN ULKUS DIABETIK

Diabetic ulcer patients are at risk of anxiety due to changes in health status, wound conditions, fear of amputation, treatment costs and even the threat of death. Anxiety can decrease quality of life as well as hinder wound healing. Education on wound development is important so that patients know the condition and changes in the wound. Research design pre-post test control group design. The sample of 30 diabetic ulcers was divided into two groups, namely the treatment group who received wound development education based on wound photos and the control group who received wound development education without wound photos. Anxiety scores were measured before and after the intervention using the Zung Self-Rating Anxiety Scale questionnaire. The results of the study in the treatment group decreased anxiety scores after the intervention with a mean value of 56.60 and in the control group after the intervention the mean value was 61.47. The results of statistical analysis using the Mann Whitney test obtained a value of p = 0.036. Conclusion that wound development education based on wound photos is effective in reducing anxiety in diabetic ulcer patients. It is recommended for nurses to provide education on wound development accompanied by photos after treatment.

Psychosocial Care for People With Diabetic Neuropathy: Time for Action.

Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.

Psychosocial research in the diabetic foot: Are we making progress?

This review summarizes recent advances regarding the role of psychological factors in people with a diabetic foot ulcer (DFU). It describes the detrimental effects of diabeticfoot complications and in particular, Charcot Neuroarthropathy (CN), on health status and quality of life (QoL) and emphasizes the importance of utilizing DFU-specific assessment tools. Diabetic neuropathy (DN)-related postural instability is key in generating depression in high DFU risk patients and in predicting offloading non-adherence those with active DFUs. Patients' views of their own DFU risk are largely inconsistent with biomedical models, resulting in a lack of preventive foot self-care. Furthermore, DFUs are a source of specific emotional responses, with fear of amputation predominant. While fear of amputation is associated with better preventive foot self-care, it appears to be linked to DFU non-healing, though mechanisms are yet to be elucidated. Until now, systemically released stress hormones were recognized as the only biological mechanism through which psychological stress influences healing. Recently, the skin has been found to be an extra-adrenal site for glucocorticoid synthesis with local, tissue-specific cortisol implicated in DFU non-healing. These observations could potentially lead to future targets for therapeutic and psychological interventions.

Therapeutic Itinerary and Causes of Delay in Specialized Consultation of Patients Admitted for Diabetic Foot

Introduction: Amputation remains a common practice in patients admitted for diabetic foot. The delay in consultation is one of the main reasons. The objective of this work was to analyze patients’ itinerary care and to identify the causes of delay in consultation in patients admitted for diabetic foot. Method: This is a descriptive cross-sectional study, including all patients hospitalized for diabetic foot. A wait of at least seven (7) days before consulting the Endocrinology department of Hubert Koutoukou Maga Teaching Hospital (CNHU-HKM) after the foot injury occurred was considered as delay in consultation. The data were recorded and analyzed in the EPI INFO software. The description of the sample was made according to the usual statistics (frequency, average, standard deviation). Results: Seventy-six (76) diabetic foot cases were admitted during the period of the study. The mean age of the patients was 56.64 ± 10.71 years with extremes of 29 years and 84 years. Patients were most often received at an advanced stage of the foot injury, 3D stage of Texas classification in 87% of cases and Wagner grades 4 and 5 in 52% of cases. The amputation rate was 38.16%. An analysis of the first care places reveals that 90.8% of patients had consulted conventional medicine, 13.2% in traditional medicine; 1.2% had religious practices and 18.7% had declared self-medication at home. Consultation period at CNHU HKM was more than 7 days in 80% of cases and less than 7 days in 20% of cases. The average consultation time was 44.08 ± 26.43 days with extremes of 1 and 480 days. The main reasons for the delay in seeking hospital care cited by diabetic patients were fear of amputation (47.8% of cases), economic difficulties (32.5% of cases) and awareness lack of the situation seriousness (22.4%). Conclusion: The therapeutic itinerary of patients with diabetic foot was particularly long. The main reasons of late appeal to specialized care were fear of amputation and economic difficulties. The implementation of universal health insurance and an information, education and communication program could certainly reduce the periods allowed for recourse to care and therefore to reduce the amputation rate.

Reasons for Patronage of Traditional Bone Setters.

Aims and Objectives:The objectives of this study were to analyze the different reasons why patients with fractures patronize traditional bone setters (TBS) and their impression of the outcome of the treatment by the TBS.Materials and Methods:A 24 month prospective observational study was conducted from February 2012 to January 2014. All the patients were recruited from the orthopedics outpatient clinic. The demographic data of each patient, the type of injury, presentation to hospital or not, reasons for leaving the hospital, reasons for patronage of the TBS and their impression of the outcome of TBS’ treatment, effect of educational background on patronage of TBS and reason for presenting to hospital for orthodox treatment.Data Analysis:Analysis was done with SPSS software Version 20.Results:A total 79 patients were recruited for the study and they had different reasons for patronizing TBS. These reasons include an external locus of decision making in 19 (24.1%) patients, and greater faith in TBS compared to orthodox medicine in 16 (20.3%). Twelve (15.2%) believed that TBS are more competent than orthodox medical practitioners while another group 11 (13.9%) considered the fees of TBS cheaper than those in the hospital. The delay in treatment in the hospital, forceful removal of patients from hospital against their will and nonsatisfaction with hospital treatment accounted for 5 (6.3%). Poor attitude of hospital staff, fear of amputation, and patients being unconscious during the injury accounted for 2 (2.5%). Their ages ranged from 17 to 83 years, with mean age of 36.8 ± 11.8 years. The male: female ratio was 1.5:1.Conclusions and Recommendations:With recent advancements in the practice of orthopedics and trauma, there is still a very high patronage of the TBS by most of our patients. This is largely due to the dependence of the patients on their sponsors for treatment, while the influence of cultural and religious beliefs continues to play a major role in these decisions.

Patronage of traditional bonesetters in Makurdi, north-central Nigeria.

BackgroundDespite the numerous complications associated with traditional bonesetters’ (TBS) practices, their patronage has remained high in developing countries. The aim was to study the reasons patients seek TBS treatment.MethodsThis was a descriptive hospital-based study of 120 patients who were treated by TBS. The sociodemographic profile of the patients, details of injuries sustained, reasons for TBS patronage, duration of TBS treatment, the number of TBS visited, the reason for abandoning TBS treatment, patients’ belief about the TBS practice, and outcome of their treatment were studied.ResultsOut of 418 patients who presented with musculoskeletal injuries, 120 patients who had been treated by TBS before presentation met the inclusion criteria. The mean age of the patients was 37.4±10.5 years. Advice of relatives and friends, as seen in 35 (29.2%) patients, was the most common reason for TBS patronage. Other reasons were cheaper cost (number [n]=30; 25%), sociocultural belief (n=17; 14.2%), easy accessibility (n=15; 12.5%), fear of amputation (n=13; 108%), and fear of operation (n=10; 8.3%). There was no correlation between these factors and age, marital status, occupation, and educational status (P=0.41). Forty-two (35%) patients believed TBS were not useful, a nuisance (n=30; 25%), useful (n=38; 31.7%), or indispensable (n=10; 8.3%). The opinion of patients about the outcome of TBS practice was: very satisfactory (n=0; 0%); satisfactory but with deficiencies (n=24; 20%); unsatisfactory (n=80; 66.7%); and no idea (n=16; 13.3%).ConclusionAdvice of relatives and friends was the main reason for patronizing TBS. The majority of patients lost confidence in the TBS practice after patronizing them due to the high complication rate.

Treatment of large posttraumatic tibial bone defects using the Ilizarov method: a subjective outcome assessment

The treatment of large posttraumatic tibial bone defects using the Ilizarov method was shown to be successful in several studies. These studies, however, typically focus on the radiological and functional outcome using objective parameters only. The aim of the present study was therefore to assess the objective and subjective outcome of a consecutive series of patients with large posttraumatic tibial bone defects using the Ilizarov method. Additionally, it was our goal to assess the physical and mental stress for the patients and their relatives during the long treatment period and the general health status at final follow-up. A consecutive series of 15 patients with posttraumatic tibial bone defects of >30 mm after sustaining open tibial fractures and failure of internal fixation was included. The objective outcome was assessed at final follow-up using Paley's criteria. For the assessment of the subjective outcome, all patients were asked to evaluate their satisfaction with the function of the lower leg, the cosmetic appearance and overall outcome as well. The physical and mental stress of the treatment for the patients and the nearest relative of patients were assessed at the time of frame removal using a custom-made questionnaire. The SF-36 was used to evaluate the general health status at final follow-up. Solid bone union with stable soft tissue coverage and eradication of infection was achieved in all patients despite a high complication rate. The functional outcome at final follow-up was excellent or good in all patients. The patients' satisfaction with the overall outcome and the function of the lower extremity was high as well. The fear of amputation and complications was the major subjective burden for both the patients and their relatives. The long external fixation time is another relevant issue. The Ilizarov method is a safe option for the treatment of large posttraumatic tibial bone defects after failure of internal fixation despite the high complication rate. It is essential to comment this to the patients and their relatives prior to the application of the frame increase their compliance with the long and emotionally draining treatment. The Ilizarov method is worth the effort only in patients, who will presumably comply with this treatment option and all of its drawbacks.

Perceived Risk of Amputation, Emotions, and Foot Self-care Among Adults With Type 2 Diabetes

The purpose of this study was to determine the influence of having a family member who experienced an amputation on one's own perceived risk and fear of experiencing a diabetes-related amputation. This was a descriptive cross-sectional study using paper-and-pencil surveys by mail. Adults with type 2 diabetes and a family history of diabetes attending a self-management education program in the Metropolitan New York/New Jersey area were recruited. Measures were completed about risk perception and fear of amputation, emotional representations of diabetes from the Illness Perception Questionnaire, and the foot self-care behavior component of the Summary of Diabetes Self-care Activities Survey. The authors estimated the variability in foot self-care that was accounted for by risk perception and fearful memories. In those who remembered a family member needing an amputation, high perceived risk and fear was associated with less routine foot self-care. For those without family history of amputation, fear was positively associated with foot self-care. Motivation for foot self-care behavior may be driven by risk perception and emotional responses. The ways in which risk perception and fear influence motivation for preventive foot self-care behavior are influenced by whether one's family member was affected by an amputation. Probing about the influence of the patient's legacy of diabetes may be helpful when customizing education plans.

Perspectives on clinic attendance, medication and foot-care among people with diabetes in the Torres Strait Islands and Northern Peninsula Area.

To achieve a better understanding of the perspectives and needs of Indigenous people with diabetes in the Torres Strait and to identify ways to promote successful self-management of diabetes. Descriptive study collecting qualitative data in focus groups and in-depth interviews. Analysis of three key areas of diabetes self-care, namely attending appointments at the clinic, monitoring blood glucose levels and taking medication and foot-care. Informal settings in remote communities of the Torres Strait and Northern Peninsula Area of Far North Queensland. Sixty-seven Torres Strait Islanders (26 men and 41 women) with diabetes from eight Torres Strait and Northern Peninsula Area communities. A better understanding of the views, enabling factors and barriers that people experience when managing their diabetes in remote Torres Strait communities. Participants who expressed satisfaction with clinical-initiated sessions when called highlighted positive relationships and encouraging feedback from doctors. People's attitudes and practices related to oral and injectable treatments varied widely, possibly linked to levels of understanding. Widespread knowledge of foot-care and fear of amputation in an environment highly conducive to foot sores and infection was evident. Generally, participants wanted more education and personal support in all areas of diabetes care. Service providers in health and other sectors need to place more emphasis on supporting self-management of diabetes within the family and community environment.

Well-being and concerns of patients with peripheral arterial occlusive disease.

Peripheral arterial obstructive disease (AOD) affects an estimated 2.4 million persons in the United States, resulting in disability, morbidity, and even death in the elderly. Insight into the general well-being (GWB) of patients who have AOD can enhance the comprehensiveness of nursing care provided to these patients. GWB was examined in a study of 170 patients with peripheral AOD treated at a Veterans Affairs Medical Center (VAMC). The GWB instrument constructed by Dupuy and used extensively by the Rand Corporation was administered to provide an objective measure of well-being. Two open-ended questions regarding patients' concerns associated with their AOD provided more subjective information. The mean GWB score for the VAMC patients was lower than the mean score reported by the Rand Corporation for a group of healthy individuals, and this lent support to the construct validity of the instrument. The general health and vitality subscales appeared to have the widest difference in mean scores. Within the VAMC patient sample, GWB did not vary among age groups but did vary slightly in an inverse direction with the severity of the circulatory impairment. The concerns noted included fear of increased pain, lack of mobility, and fear of amputation.