Risk Factors For Ulcers Research Articles

Predicting Rebleeding in Patients with Idiopathic Peptic Ulcers

The major risk factors for peptic ulcers that bleed are H. pylori and nonsteroidal anti-inflammatory drugs (NSAIDs). However, idiopathic peptic ulcers,

Developing risk-adjusted quality indicators for pressure ulcers in long-term care hospitals in the Republic of Korea.

Pressure ulcers result in financial losses, including the cost of unnecessary medical expenses because of extended hospital stays, treatment, and examination. This was a retrospective, observational, methodological study to develop quality indicators related to pressure ulcer development and validate risk adjustment factors for pressure ulcer development. We performed a literature review to develop risk adjustment factors, and an expert group performed a content validity test. To validate risk adjustment factors for pressure ulcer development using electronic medical records, 127 patients admitted to a long-term care hospital in South Korea from June to September 2015 were enrolled in the study. Pressure ulcer risk factors were peripheral vascular disease, end-stage disease, past pressure ulcer history, high risk group for pressure ulcer development, fever, haemoglobin, and albumin (all P < 0.05); only albumin (odds ratio: 0.210, P < 0.001) was significantly associated with pressure ulcer development as an independent risk factor. Further research with a large sample size is needed for the validation of risk adjustment factors. Risk-adjusted quality indicators for pressure ulcer development can be used to evaluate the quality of nursing care and compare outcomes after preventive pressure ulcer care activities or between long-term care hospitals.

Risk of Upper Gastrointestinal Bleeding and Gastroduodenal Ulcers in Persons With Schizophrenia: A Danish Cohort Study.

INTRODUCTION:There is little evidence about gastrointestinal (GI) disorders in patients with schizophrenia. We examined association of schizophrenia with upper GI bleeding (UGIB) and nonbleeding ulcers and associated risk factors and mortality.METHODS:We used the data linked from population-based registries in Denmark. Among patients with incident schizophrenia in 1980–2011, we computed cumulative incidences and standardized incidence ratios of UGIB, bleeding ulcers, and nonbleeding ulcers compared with the general population; evaluated risk factors for the 3 GI endpoints, including somatic and psychiatric comorbidity; and examined subsequent all-cause mortality.RESULTS:Among 39,998 patients with schizophrenia, the standardized incidence ratios were 2.92 (95% confidence interval (CI), 2.76–3.08) for UGIB, 2.36 (95% CI, 2.15–2.58) for bleeding ulcers, and 2.00 (95% CI, 1.87–2.15) for nonbleeding ulcers. Risk factors for UGIB and nonbleeding ulcers included age, somatic comorbidity, and medication use. UGIB and nonbleeding ulcers were associated with the subsequent increase in mortality.CONCLUSIONS:Schizophrenia is associated with an increased risk of UGIB and nonbleeding ulcers, whose risk factors in patients with schizophrenia are similar to those in the general population.

The value of transcutaneous oxygen pressure/transcutaneous carbon dioxide pressure monitoring in early warning of the observing patients in emergency department

Objective To analyze the relevant factors of early warning in emergency patients with high risk of acute sores, explore the application value of transcutaneous oxygen pressure (TcPO2) and transcutaneous carbon dioxide pressure (TcPCO2) monitoring in the early warning of emergency patients with pressure ulcers. Methods This was a study of 186 consecutive emergency patients who were under care in the emergency department. The transcutaneous oxygen/carbon dioxide pressure monitor was used in monitoring the oxygen saturation of the skin of sacrococcygeal region and the chest. Meanwhile, the Braden scale was used in assessing risk factors for pressure ulcers and the receiver operating characteristic curve (ROC curve) was applied to evaluate the early prediction of pressure sore with TcPO2/TcPCO2 monitor. Results Implementing the logistic regression model with six indicators, this research concluded that TcPO2 CV and PO2 were independent risk factors for the development of Braden scale in patients with high risk. The area under the ROC curve showed that TcPO2 CV had a excellent predictive value for the high-risk group and determined its cut-off value to be 20%. Which means patient with both a value of TcPO2CV over 20% and a high risk of Braden scale had a larger possibility of pressure ulcers. Conclusions TcPO2 CV was an independent risk factor for patients under emergency care to develop pressure ulcers. A value of TcPO2CV over 20% indicated a high risk of pressure ulcers. Key words: Braden Risk Assessment Scale; Emergency observation; Transcutaneous oxygen pressure/transcutaneous carbon dioxide pressure; Pressure injury; Variation coefficient of transcutaneous oxygen pressure

Ulcerated tophaceous gout

Gout is a common inflammatory arthropathy with a high prevalence worldwide. Increased levels of uric acid in the blood lead to deposition of monosodium urate crystals in the joints, inflammation, and pain. Acute gout attacks are often sudden, monoarticular, and typically resolve within a week, whereas chronic gout is often polyarticular with baseline pain between attacks. In chronic gout, depositions of uric acid known as tophi can form throughout the body. Despite the high prevalence of gout and the frequency with which tophi occur, ulceration over tophi is surprisingly rare. We report the case of a 38-year-old man, undiagnosed with gout, who presented to clinic for evaluation of ulcers with chalky white granules. The wounds were determined to be ulcerated tophaceous gout. Risk factors for ulceration over tophi and reported treatments are discussed.

Foot Kinetic and Kinematic Profile in Type 2 Diabetes Mellitus with Peripheral Neuropathy A Hospital-Based Study from South India.

A kinetic change in the foot such as altered plantar pressure is the most common etiological risk factor for foot ulcers in people with diabetes mellitus. Kinematic alterations in joint angle and spatiotemporal parameters of gait have also been frequently observed in participants with diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy leads to various microvascular and macrovascular complications of the foot in type 2 diabetes mellitus. There is a gap in the literature for biomechanical evaluation and assessment of type 2 diabetes mellitus with DPN in the Indian population. We sought to assess and determine the biomechanical changes, including kinetics and kinematics, of the foot in DPN. This cross-sectional study was conducted at a diabetic foot clinic in India. Using the purposive sampling method, 120 participants with type 2 diabetes mellitus and DPN were recruited. Participants with active ulceration or amputation were excluded. The mean ± SD age, height, weight, body mass index, and diabetes duration were 57 ± 14 years, 164 ± 11 cm, 61 ± 18 kg, 24 ± 3 kg/m2, and 12 ± 7 years, respectively. There were significant changes in the overall biomechanical profile and clinical manifestations of DPN. The regression analysis showed statistical significance for dynamic maximum plantar pressure at the forefoot with age, weight, height, diabetes duration, body mass index, knee and ankle joint angle at toe-off, pinprick sensation, and ankle reflex ( R = 0.71, R2 = 0.55, F12,108 = 521.9 kPa; P = .002). People with type 2 diabetes mellitus and DPN have significant changes in their foot kinetic and kinematic parameters. Therefore, they could be at higher risk for foot ulceration, with underlying neuropathy and biomechanically associated problems.

The role of amputative and non-amputative foot deformities severity in the risk for diabetic ulceration classification systems building: a cross-sectional and case-control pilot investigation.

IntroductionFoot deformities and amputations are parameters that have been studied as risk factors for diabetic foot ulceration (DFU). However, inclusion of “foot deformities” and “amputations” in a single, broad variable and with reference to the severity of these deformities, may better characterize subjects who are prone to develop DFU.MethodsThe objective of the study was the examination of amputative and non-amputative foot deformities severity as risk factor for DFU in relation with the other established risk factors. A cross-sectional and case-control study was conducted from October 2005 to November 2016. One hundred and thirty-four subjects with type 1 and 2 diabetes, with and without active foot ulcers, participated. A structured quantitative interview guide was used. Univariate logistic regression analysis for the literature's established risk factors was performed, as well as for two versions of the “amputative and non-amputative foot deformities severity” variable. Subsequently, multivariate logistic regression analysis (MLRA) for three models and receiver operating characteristic (ROC) curve analysis were carried out.ResultsFrom the MLRA, only PAD (peripheral arterial disease) was significant (OR 3.56, 95% CI 1.17-10.82, P=0.025 and OR 3.33, 95% CI 1.02-10.08, P=0.033). Concerning the ROC curve analysis of the models, the one with the three categories amputative and non-amputative foot deformities severity variable, had the greatest area under the ROC curve (0.763, P<0.001).ConclusionA united variable for lower extremity amputations and other foot deformities with reference to their severity, could be more helpful to the clinicians in identifying patients with diabetes at risk for foot ulceration.

Risk Factors of Medical Device-Related Pressure Ulcer in Intensive Care Units

The purpose of this study was to identify the characteristics of and risk factors for medical-device-related pressure ulcer (MDRPU) development in intensive care units. A prospective cohort study design was used, and the participants were 253 adult patients who had stayed in medical and surgical intensive care units. Data were collected regarding the application of medical devices and MDRPU-related characteristics over a period of six months from June to November, 2017. Data were analyzed using independent t-test, χ²-test, Fisher's exact test, and binary logistic regression analysis with the SPSS 21.0 program. Among the 253 participants, MDRPUs occurred in 51 (19.8%) participants. The results of the logistic regression analysis showed that the risk factors for MDRPUs were the use of endotracheal tubes (OR=5.79, 95% CI: 1.66~20.20), having had surgery (OR=2.95, 95% CI: 1.11~7.77), being in a semi-coma/coma (OR=5.79, 95% CI: 1.04~32.05), and sedation (OR=5.54, 95% CI: 1.39~22.19). On the basis of the study results, it is effectively facilitated by nurses when they care for patients with MDRPUs in intensive care units and the results are expected to be of help in preventive education for MDRPU development as well as preparing the base data for intervention studies.

Economic impact of pharmacist interventions on correction of stress-related mucosal damage prophylaxis practice.

IntroductionStress-related mucosal damage (SRMD) is described as the damage of gastric mucosa due to physiological stress that is a very common complication in critically ill patients. SRMD prophylactic medications are widely prescribed all over the world, while numerous studies have revealed that a large percentage of patients admitted to non-intensive care unit (ICU) services do not need to receive these medications. The aim of this study was to determine the frequency and type of medication errors and the economic impact of clinical pharmacist intervention on stress ulcer prophylaxis (SUP).MethodsThis prospective interventional study was conducted on adult patients admitted to internal, surgical, and critical care units at two large academic medical centers over 6 months. Risk factors of stress ulcer were recorded daily during hospital stay, and appropriateness of SUP administration was assessed according to the American Society of Health-System Pharmacists (ASHP) criteria. An intervention was performed by a clinical pharmacist in the case of contradictions. The rate of inappropriate SUP and the economic impact of a pharmacist intervention were recorded.ResultsIn this study, 178 out of 219 (81.2%) patients received prophylactic treatments. Averagely, prophylactic therapy was compatible with standard treatment guidelines in 67.1% of cases. The implementation of ASHP guideline by a clinical pharmacist resulted in a cost saving of >18,000 USD monthly in this study, which would result in an estimated cost saving of >216,000 USD annually.ConclusionAlthough treatment guidelines are available for the prophylaxis of SRMD, failure to observe these guidelines could increase the cost of treatment and adverse effects. The clinical pharmacists’ intervention in order to implement standard protocols has a significant impact on the reduction of unintended mistakes in prescribing prophylaxis, as well as significant cost savings.

SU34 - DISTINCT GENETIC PROFILES OF PEPTIC ULCER IN INDIVIDUALS WITH DEPRESSION

Background Peptic ulcer is a common yet serious disease affected about 4 million people worldwide. Depression is considered a risk factor for peptic ulcer and may modify the etiology underlying peptic ulcer. Genetic factors contribute on the risk of developing peptic ulcer, but it remains unclear whether the genetic influences differ between depressed and non-depressed groups. In this study, we conducted genome-wide association studies for peptic ulcer stratified by depression status in Taiwanese samples. Methods Subjects in this study were drawn from Taiwan biobank with detailed demographic and clinical data collection. A total of 10,295 individuals were initially included, and 9,862 participants were retained after quality control, which consisted of 1,218 (12%) depression individuals based on prior diagnosis of major depressive disorder or high scores of self-report patient health questionnaire for depression and anxiety (scores greater than 3). Genetic association analyses were performed using logistic regression models while adjusted for age and sex. A p-value less than 10-5 was considered with suggestive association signals. Results Within depressed group, the top three associated SNPs were rs4775785 (P-value=1.20×10-7), rs10162880 (P=4.38×10-7) and rs7177833 (P=5.17×10-7). After gene mapping, these top SNPs were all map to the SHC4 gene, a protein coding gene on chromosome 15. In the non-depressed group, a different set of associated SNPs were observed, with rs11238817 (P=2.16×10-6) and rs11637781(P=4.41×10-6) showing suggestive signals without mapped to known coding genes. Discussion There is no overlapping markers or genes for peptic ulcer between the depressed and non-depressed groups, indicating different genetic profiles among the two groups. A replication study is needed with larger sample size, especially for the identified gene located on chromosome 15 in depressed individuals.

Diabetic foot ulcer: risk factors among patients of a secondary healthcare facility in south west Nigeria

Background : Diabetic foot ulcer is a common long term complication of diabetes and the most common cause of non-traumatic amputation and prolonged hospitalization. These increases disease burden and further worsen quality of life. Aim : This study evaluated exposure risk factors for foot ulcers among diabetics attending a secondary healthcare facility in Southwest Nigeria. Methods : A case control study of exposure risk factors for diabetes foot ulcer (DFU) at General Hospital Marina Lagos. Using a structured interviewer administered questionnaire, information on foot care education, 24-hour dietary recall, medical history, anthropometric indices and social habits of participants were obtained and analyzed. Results : There were 636 participants in this study (106 cases and 530 controls) with median age of 61.1±11.0 years in both study groups and mostly females, (75.5% in cases and 78.7% controls) with female to male ratio of 3:1. Majority, (83% in cases and 85% in controls) were in the low socioeconomic class and had lived with DM for more than 5years. Of the studied risk factors, lacking foot care education, diagnosis of visual impairment and hypertension, dietary intake of large proportion of carbohydrate meal at breakfast and dinner and obesity occured in significantly higher proportion of cases and controls and were associated with presence of DFU. (p<0.05) Conclusions : Lack of foot care education, diagnosis of visual impairment, hypertension and poor dietary habit are associated with presence of DFU. Addressing these factors from point of diagnosis will go a long way in stemming the burden of diabetes foot ulcer. Funding: Self-funding. Keywords: Diabetes, foot ulcer, exposure risk factors, Southwest Nigeria.

Assessment of peripheral arterial disease in diabetic adults with foot ulcers in an African population

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Peripheral arterial disease (PAD) is a recognized risk factor for diabetic foot ulceration. It was thought that PAD is not common in Sub-Saharan Africa. Studies show otherwise. It becomes necessary to assess the prevalence of PAD among diabetic adults with foot ulcers in Nigeria. The objective of the study was to assess the prevalence of PAD in diabetic subjects with foot ulcers in Nigeria.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Diagnosis of PAD was made with the ankle-brachial index (ABI). Edinburgh claudication questionnaire was administered to the patients. An ABI of &amp;lt;0.9 is diagnostic of PAD. Risk factors for PAD were assessed. A control group of non-diabetic adults was used.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Sixty-seven per cent (67%) of the test group has PAD as compared to 18% of the control group. Smoking, duration of diabetes and systemic hypertension were strongly associated with PAD.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Diabetic adults with foot ulcers in Nigeria have a high prevalence of PAD.&lt;/p&gt;

CYP2C19*2 polymorphism in Polish peptic ulcer patients.

CYP2C19 isoenzyme of cytochrome P450 in the liver catabolises proton pump inhibitors, one of the therapeutics utilized in Helicobacter pylori eradication therapy, and in this way could influence the eradication effectiveness. The isoensyme contributes also to metabolism of endogenous substances, which derivatives are involved in the pathogenesis of peptic ulceration. CYP2C19*2 polymorphism (rs4244285) changing the CYP2C19 function could be relevant in the predisposition to peptic ulcer disease. CYP2C19*2 polymorphism in 197 peptic ulcer patients and 107 healthy subjects of Polish origin by PCR-RFLP method was investigated. There were no statistically significant differences in genotypes and alleles frequencies for investigated polymorphism between peptic ulcer patients and healthy individuals. No associations between frequencies of particular CYP2C19 genotypes and alleles and the presence of H. pylori infection in peptic ulcer patients were stated. However, significant association between CYP2C19*2 and gender in H. pylori-infected but not -uninfected peptic ulcer individuals was found. Investigated polymorphism is not a risk factor for peptic ulcer in Polish population. Obtained results could suggested there is some interaction between gender, CYP2C19*2 polymorphism, and pathogenesis of H. pylori infection development. However, this hypothesis should be verified in the further studies.

Characteristics among adult patients with diabetes who received a foot exam by a health care provider in the past year: An analysis of NHANES 2011–2016

IntroductionAccording to the American Diabetes Association (ADA), patients with diabetes should receive annual foot exams from a HCP to identify and reduce risk factors for ulcers and other complications. Little is known regarding factors that may increase or decrease the likelihood of having an annual foot examination by a health care provider (HCP). MethodsCross-sectional analysis of 1830 patients age 20 years and older with a previous diagnosis of diabetes. Patients selected for inclusion in NHANES receive an in-home interview and then undergo a comprehensive physical at a CDC mobile examination center. The adjusted odds ratios for a patient having received a foot exam from a HCP in the past year were conducted using appropriate weighting variables assessed with logistic regression analysis. ResultsBoth Hispanic Americans with diabetes [aOR 0.62 (0.47, 0.82)] and Asian Americans with diabetes [aOR 0.65 (0.44, 0.97)] were significantly less likely to have had a foot exam by a HCP in the last year, when compared to non-Hispanic White Americans. ConclusionsHispanic Americans and Asian Americans with diabetes were significantly less likely to have had a foot exam by a HCP in the last year.

A Diabetic Foot Survey

Introduction: Diabetic foot has been defined by the International Working Group on the Diabetic foot and World Health Organisation as a Diabetic patient’s foot, associated with neuropathy, ischaemia or both, which has lead to ulceration, infection and/or deep tissue destruction An association of diabetic retinopathy with risk factors of Diabetic foot ulcer has been seen. Hence it is important to assess diabetic patients for risk factors leading to diabetic foot and tally these risks with diabetic retinopathy to help early diagnosis and management of diabetic foot and diabetic retinopathy.&#x0D; Methodology: This is a community based survey of a cohort of randomly presented patients examined on a first come first service basis limited to maximum of 100 patients to be reviewed in a day in a free health camp in Jaishi Dewal, Kathmandu, Nepal. The data of the patients were noted in a proforma documenting risks of diabetic foot and diabetic retinopathy.&#x0D; Results: Out of the 82 patients reviewed in the medical camp 38 were diabetic (type 2) with a mean age of 60.29 years being more common in females. Risk of Diabetic foot did have a definite association with level of education more common in the lesser educated and occupation (commonest in housewives). Awareness of risk of diabetic foot was only among 39.5% of the diabetic patients. Diabetic retinopathy was also seen only among 18.4% of the diabetic patients, being more common in the educated.&#x0D; Conclusion: Education and awareness programmes towards diabetic foot protocol are important despite the level of education or occupation. In diabetic patients, it is important to screen for risks of diabetic foot especially if patient has a history of hypertension and also screen for diabetic retinopathy.&#x0D;

The effect of Lactobacillus reuteri supplementation in Helicobacter pylori infection: a placebo-controlled, single-blind study

BackgroundHelicobacter pylori is the major cause of chronic gastritis, and considered as a risk factor for peptic ulcer and gastric cancer. The H. pylori standard antibiotic therapy fails in about 25–30% of cases, particularly because of the increasing occurrence of resistance to antibiotics. The aim of the current study was to investigate whether the strain Lactobacillus reuteri DSM17648 which has been previously shown to reduce Helicobacter pylori load additionally improves gastrointestinal symptoms in H. pylori positive subjects when used in a 28 days supplementation.MethodsIn a single-blinded, placebo controlled study 24 H. pylori-positive adults (13 females, 11 males; median age: 43.5) with mild dyspepsia (mean GSRS score: 11.82) received placebo for 28 days followed by Pylopass™ containing the L. reuteri DSM 17648 (2 × 1010 cells per day) for the following 28 days. After 28 days of Pylopass™ supplementation the change in H. pylori load was measured by 13C urea breath test (13C-UBT) and the change in symptoms were determined by the Gastrointestinal Symptom Rating Scale (GSRS). In addition, blood assessments were conducted to measure the physiological changes relevant in terms of safety.ResultsAfter a 28-day supplementation phase with Pylopass™ there was a trend for reduction of H. pylori load in 62.5% of the subjects and for the overall GSRS scores in 66.7% of subjects. The overall GSRS scores from baseline to day 56 following all 24 subjects undergoing the placebo phase followed by the Pylopass™ phase was significantly decreased (p = 0.005). The mean 13C-UBT δ value decreased by 22.5% during the Pylopass™ supplementation phase (− 3.14), while the mean 13C-UBT δ increased by 37.3% (+ 3.79) in the placebo phase. No side effects were reported in either study phase.ConclusionThe results demonstrated that L. reuteri DSM17648 has the potential to suppress H. pylori infection, and may lead to an improvement of H. pylori-associated gastro intestinal symptoms. Further studies with adequate power should be performed.Trial registrationClinicaltrials.gov: NCT02051348 (January 30, 2014).

The epidemiology of skin ulcers in saltwater reared Atlantic salmon (Salmo salar) in Atlantic Canada

Skin ulcers have been increasing in occurrence on Atlantic salmon (Salmo salar) farms in Atlantic Canada during summer and autumn months when water temperatures are elevated above 10 °C. The clinical presentation in Atlantic Canada resembles lesions associated with winter ulcer disease in Europe caused by Moritella viscosa, but this bacterium is not always identified from skin lesions in North American cases. The objectives of our study were to: 1) describe the onset, duration, magnitude, and temporal and spatial distributions of Atlantic Canadian skin ulcer cases at the cage and farm levels; 2) develop hypotheses regarding potential sources and transmission routes for infection based on the patterns of disease occurrence; and 3) identify potential risk factors associated with total percent mortality during skin ulcer outbreaks. We summarized weekly cage-level data from 29 salmon farms in Atlantic Canada, from April 2014 to January 2016. Cage and farm-level prevalence, onset, duration, and total percent mortality associated with skin ulcer outbreaks were determined. The association of potential risk factors for skin ulcers with total percent mortality during skin ulcer outbreaks was assessed using a mixed-effects linear regression model with random farm effects. The overall farm-level prevalence of skin ulcers on Atlantic Canadian farms included in our study was 41%. The descriptive epidemiology of skin ulcers suggests cages are likely exposed to the causative agent(s) only at certain times of the year and exposure is not uniform across farms based on the patterns of disease occurrence. The onset of skin ulcer outbreaks in our study occurred from late-summer to mid-autumn. The pattern of disease is also suggestive of point source exposures to the causative agent across farms. In our final regression model, year of outbreak onset, and the interaction between the diagnosis of skin ulcers at the cage level and antibiotic treatment during the outbreaks were significantly associated with the log of total percent mortality during the outbreaks (P < .001). Our results did not identify any management factors that could reduce the severity of skin ulcer outbreaks on affected farms.

ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats.

The gastrointestinal (GI) mucosal barrier is continuously exposed to noxious toxins, reactive oxygen species, microbes, and drugs, leading to the development of inflammatory, erosive, and ultimately ulcerative lesions. This report offers a consensus opinion on the rational administration of GI protectants to dogs and cats, with an emphasis on proton pump inhibitors (PPIs), histamine type‐2 receptor antagonists (H2RAs), misoprostol, and sucralfate. These medications decrease gastric acidity or promote mucosal protective mechanisms, transforming the management of dyspepsia, peptic ulceration, and gastroesophageal reflux disease. In contrast to guidelines that have been established in people for the optimal treatment of gastroduodenal ulcers and gastroesophageal reflux disease, effective clinical dosages of antisecretory drugs have not been well established in the dog and cat to date. Similar to the situation in human medicine, practice of inappropriate prescription of acid suppressants is also commonplace in veterinary medicine. This report challenges the dogma and clinical practice of administering GI protectants for the routine management of gastritis, pancreatitis, hepatic disease, and renal disease in dogs and cats lacking additional risk factors for ulceration or concerns for GI bleeding. Judicious use of acid suppressants is warranted considering recent studies that have documented adverse effects of long‐term supplementation of PPIs in people and animals.

The development and validation of a multivariable prognostic model to predict foot ulceration in diabetes using a systematic review and individual patient data meta-analyses.

Diabetes guidelines recommend screening for the risk of foot ulceration but vary substantially in the underlying evidence base. Our purpose was to derive and validate a prognostic model of independent risk factors for foot ulceration in diabetes using all available individual patient data from cohort studies conducted worldwide. We conducted a systematic review and meta-analysis of individual patient data from 10 cohort studies of risk factors in the prediction of foot ulceration in diabetes. Predictors were selected for plausibility, availability and low heterogeneity. Logistic regression produced adjusted odds ratios (ORs) for foot ulceration by ulceration history, monofilament insensitivity, any absent pedal pulse, age, sex and diabetes duration. The 10 studies contained data from 16385 participants. A history of foot ulceration produced the largest OR [6.59 (95% CI 2.49 to 17.45)], insensitivity to a 10g monofilament [3.18 (95% CI 2.65 to 3.82)] and any absent pedal pulse [1.97 (95% CI 1.62 to 2.39)] were consistently, independently predictive. Combining three predictors produced sensitivities between 90.0% (95% CI 69.9% to 97.2%) and 95.3% (95% CI 84.5% to 98.7%); the corresponding specificities were between 12.1% (95% CI 8.2% to 17.3%) and 63.9% (95% CI 61.1% to 66.6%). This prognostic model of only three risk factors, a history of foot ulceration, an inability to feel a 10g monofilament and the absence of any pedal pulse, compares favourably with more complex approaches to foot risk assessment recommended in clinical diabetes guidelines.

Risk factors for foot ulcers among patients with diabetes mellitus

Risk factors for foot ulcers among patients with diabetes mellitus