| History of the team approach to amputation prevention: pioneers and milestones. | |
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MedLine Citation:
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PMID: 20847345 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. He believed that diabetic gangrene was preventable. His remedy was a team approach that included foot care, diet, exercise, prompt treatment of foot infections, and specialized surgical care. The history of the team approach to management of the diabetic foot chronicles the rise of a new health profession-podiatric medicine and surgery-and emergence of the specialty of vascular surgery. The partnership among the diabetologist, vascular surgeon, and podiatric surgeon is a natural one. The complementary skills and knowledge of each can improve limb salvage and functional outcomes. Comprehensive multidisciplinary foot-care programs have been shown to increase quality of care and reduce amputation rates by 36% to 86%. Development of distal revascularization techniques to restore pulsatile blood flow to the foot has also been a major advancement. Patients with diabetic foot complications are among the most complex and vulnerable of all patient populations. Specialized diabetic foot clinics of the 21st century should be multidisciplinary and equipped to coordinate diagnosis, off-loading, and preventive care; to perform revascularization procedures; to aggressively treat infections; and to manage medical comorbidities. |
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Authors:
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Lee J Sanders; Jeffrey M Robbins; Michael E Edmonds |
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Publication Detail:
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Type: Historical Article; Journal Article |
Journal Detail:
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Title: Journal of the American Podiatric Medical Association Volume: 100 ISSN: 1930-8264 ISO Abbreviation: J Am Podiatr Med Assoc Publication Date: 2010 Sep-Oct |
Date Detail:
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Created Date: 2010-09-17 Completed Date: 2011-01-31 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8501423 Medline TA: J Am Podiatr Med Assoc Country: United States |
Other Details:
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Languages: eng Pagination: 317-34 Citation Subset: IM |
Affiliation:
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Podiatry Service, Veterans Affairs Medical Center, Lebanon, PA 17042, USA. sandersl@ptd.net |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Amputation
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history* Diabetic Foot / history*, surgery Europe History, 20th Century Humans Orthopedics / history* Patient Care Team / history Podiatry / education, history Societies, Medical / history United States |
| Comments/Corrections | |
Erratum In:
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J Am Podiatr Med Assoc. 2010 Nov-Dec;100(6):529 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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