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      Research priorities to prevent and treat diabetic foot ulcers—A digital James Lind Alliance Priority Setting Partnership

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          Abstract

          Aim

          To establish outcomes of a priority setting partnership between participants with diabetes mellitus and clinicians to identify the top 10 research priorities for preventing and treating diabetic foot ulcers (DFUs).

          Methods

          Due to the COVID‐19 pandemic, the James Lind Alliance Priority Setting Partnership process was adapted into a digital format which involved a pilot survey to identify understandable uncertainties with high relevance for participants tested by calculating the content validity index; a main survey answered by 53 participants living with diabetes and 49 clinicians; and a final digital workshop to process and prioritise the final top 10 research priorities.

          Results

          The content validity index was satisfactory for 20 out of 25 uncertainties followed by minor changes and one additional uncertainty. After we processed the 26 uncertainties from the main survey and seven current guidelines, a list of 28 research uncertainties remained for review and discussion in the digital workshop. The final top 10 research priorities included the organisation of diabetes care; screening of diabetes, impaired blood circulation, neuropathy, and skin properties; vascular surgical treatment; importance of self‐care; help from significant others; pressure relief; and prevention of infection.

          Conclusion

          The top 10 research priorities for preventing and treating DFUs represent consensus areas from persons living with diabetes and clinicians to guide future research. These research priorities can justify and inform strategic allocation of research funding. The digitalisation of James Lind Alliance methodology was feasible.

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          Most cited references29

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          The content validity index: are you sure you know what's being reported? Critique and recommendations.

          Scale developers often provide evidence of content validity by computing a content validity index (CVI), using ratings of item relevance by content experts. We analyzed how nurse researchers have defined and calculated the CVI, and found considerable consistency for item-level CVIs (I-CVIs). However, there are two alternative, but unacknowledged, methods of computing the scale-level index (S-CVI). One method requires universal agreement among experts, but a less conservative method averages the item-level CVIs. Using backward inference with a purposive sample of scale development studies, we found that both methods are being used by nurse researchers, although it was not always possible to infer the calculation method. The two approaches can lead to different values, making it risky to draw conclusions about content validity. Scale developers should indicate which method was used to provide readers with interpretable content validity information. (c) 2006 Wiley Periodicals, Inc.
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            The global burden of diabetic foot disease.

            Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes in the next 20 years. People at greatest risk of ulceration can easily be identified by careful clinical examination of the feet: education and frequent follow-up is indicated for these patients. When assessing the economic effects of diabetic foot disease, it is important to remember that rates of recurrence of foot ulcers are very high, being greater than 50% after 3 years. Costing should therefore include not only the immediate ulcer episode, but also social services, home care, and subsequent ulcer episodes. A broader view of total resource use should include some estimate of quality of life and the final outcome. An integrated care approach with regular screening and education of patients at risk requires low expenditure and has the potential to reduce the cost of health care.
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              Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update).

              The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis and treatment of foot infection in persons with diabetes and updates the 2015 IWGDF infection guideline. On the basis of patient, intervention, comparison, outcomes (PICOs) developed by the infection committee, in conjunction with internal and external reviewers and consultants, and on systematic reviews the committee conducted on the diagnosis of infection (new) and treatment of infection (updated from 2015), we offer 27 recommendations. These cover various aspects of diagnosing soft tissue and bone infection, including the classification scheme for diagnosing infection and its severity. Of note, we have updated this scheme for the first time since we developed it 15 years ago. We also review the microbiology of diabetic foot infections, including how to collect samples and to process them to identify causative pathogens. Finally, we discuss the approach to treating diabetic foot infections, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and for bone infections, when and how to approach surgical treatment, and which adjunctive treatments we think are or are not useful for the infectious aspects of diabetic foot problems. For this version of the guideline, we also updated four tables and one figure from the 2016 guideline. We think that following the principles of diagnosing and treating diabetic foot infections outlined in this guideline can help clinicians to provide better care for these patients.
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                Author and article information

                Contributors
                christine.kumlien@mau.se
                Journal
                Diabet Med
                Diabet Med
                10.1111/(ISSN)1464-5491
                DME
                Diabetic Medicine
                John Wiley and Sons Inc. (Hoboken )
                0742-3071
                1464-5491
                07 September 2022
                November 2022
                : 39
                : 11 ( doiID: 10.1111/dme.v39.11 )
                : e14947
                Affiliations
                [ 1 ] Department of Care Science Malmö University Malmö Sweden
                [ 2 ] Department of Cardiothoracic and Vascular Surgery Skåne University Hospital Malmö Sweden
                [ 3 ] Department of Clinical Sciences Malmö, Lund University Malmö Sweden
                [ 4 ] Department of Biomedical Science Malmö University Malmö Sweden
                [ 5 ] Biofilms—Research Center for Biointerfaces Malmö University Malmö Sweden
                Author notes
                [*] [* ] Correspondence

                Christine Kumlien, Department of Care Science, Malmö University, Jan Waldenströms gata 25, 20506 Malmö, Sweden.

                Email: christine.kumlien@ 123456mau.se

                Author information
                https://orcid.org/0000-0002-1437-5060
                Article
                DME14947 DME-2022-00110.R2
                10.1111/dme.14947
                9826297
                36054410
                15ba9406-7a73-41bc-9be9-adced9dccf2a
                © 2022 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 17 February 2022
                : 26 August 2022
                Page count
                Figures: 1, Tables: 3, Pages: 9, Words: 5113
                Funding
                Funded by: This research received funding from the Knowledge Foundation within the project “Biobarriers ‐ Health Disorders and Healing” (Grant number ‐ 20190010), the Gustaf Th Olsson Foundation, and the Faculty of Health and Society at Malmö University
                Funded by: Malmö University , doi 10.13039/501100005934;
                Funded by: Knowledge Foundation , doi 10.13039/100003077;
                Funded by: Diabetes Association , doi 10.13039/501100009707;
                Categories
                Research: Healthcare Delivery
                Research: Healthcare Delivery
                Custom metadata
                2.0
                November 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.3 mode:remove_FC converted:08.01.2023

                Endocrinology & Diabetes
                diabetic foot ulcer,digital platform,james lind alliance,prevention,priority setting partnership

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