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Diabetic foot ulcers are associated with considerable morbidity, mortality and costs to the NHS. This paper describes a review of publications reporting randomised controlled trials examining the clinical effectiveness of interventions for diabetic foot ulcers for 1986–1996. Only 23 studies were identified that described randomised controlled trials and, of these, only 4 fulfilled three criteria shown to influence reliability of results: adequate description of randomisation, double blinding and description of withdrawals and drop‐outs. No cost‐effectiveness studies conducted alongside trials were identified from the searches. This shortage of rigorous trials highlights the need for more well designed research in the prevention and treatment of diabetic foot ulcers to determine clinical effectiveness as well as relative cost‐effectiveness.

The purpose of this paper is to develop a prototype of a wearable medical device in the form of a bandage with a real-time data monitoring platform, which can be used domestically for diabetic patients to identify the possibility of foot ulceration at the early stage.

The prototype can measure blood volumetric change and temperature variation in the forefoot area simultaneously. The waveform extracted using a pulsatile-blood-flow signal was used to assess blood perfusion-related information, and hence, predict ischemic ulcers. The temperature difference between ulcerated and the reference was used to predict neuropathic ulcers. The medical device can be used as a bandage during the application wherein the sensory module is placed inside the hollow pocket of the bandage. A platform was developed through a mobile application where doctors can extract real-time information, and hence, determine the possibility of ulceration.

The height of the peaks in the pulsatile-blood-flow signal measured from the subject with foot ischemic ulcers is significantly less than that of the subject without ischemic ulcers. In the presence of ischemic ulcers, the captured waveform flattens. Therefore, the blood perfusion from arteries to the tissue of the forefoot is considerably low for the subject with ischemic ulcers. According to the temperature difference data measured over 25 consecutive days, the temperature difference of the subject with neuropathic ulcers occasionally exceeded the 4 °F range but mostly had higher values closer to the 4 °F range. However, the temperature difference of the subject who had no complications of neuropathic ulcers did not exceed the 4 °F range, and the majority of the measurements occupy a narrow range from −2°F to 2 °F.

The proposed prototype of wearable medical apparatus can monitor both temperature variation and pulsatile-blood-flow signal on the forefoot simultaneously and thereby predict both ischemic and neuropathic diabetes using a single device. Most importantly, the wearable medical device can be used domestically without clinical assistance with a real-time data monitoring platform to predict the possibility of ulceration and the course of action thereof.

This paper aims to review state of the art of techniques for dimensioning chronic wounds, and validate the possibilities of employing a new proposed optical imaging approach for general task of wound assessment.

Current techniques used for quantifying wound surface are reviewed and evaluated from various perspectives to exam their usability in wound care clinical settings. A photometric stereo (PS) approach will be identified and verified to work as an alternative solution to better satisfy practical requirements on quantifying the dimension of real and mocked wounds.

Both contact and contactless approaches provide some useful functions for wound management; however, new imaging modalities are still required for achieving good portability, affordability and applicability in assisting decision-making in clinical settings. The PS approach can work as a potential solution to provide these functionalities as well as dense geometrical and color texture information of measured areas. The experiments demonstrate that the new approach is able to conveniently produce comparable results to those from latest stereo vision-based techniques.

This work proposed and initially verified the potential of PS technique for the task of wound measurement. Substantial improvements on the prototype and more clinical trials are still required to validate the new technique before it is accepted as a tool for practical wound measurement.

This new PS approach has good potential to reliably measure the dimension of wounds as well as recover their color texture which could contain additional valuable information for predicting a healing procedure for those wound occurring deeper underneath the skin surface.

Reports on a study that focuses on the specific roles of the nurse within the interdisciplinary team as an example of how nursing contributes to developing clinical effectiveness in wound healing. The multidisciplinary team approach used here builds on recommendations by Edmonds as the most effective method of delivering care to patients with diabetic foot ulceration. In particular, monitors the evolution of the service provided and patient outcomes by measuring the number of ulcers treated, the level of service provided, record keeping and patient outcome. The contribution of the wound care nurse includes the assessment of the status and progress of ulcers presented at the clinic. Argues that, as research in wound care has evolved, so the contribution of the nurse has grown (in line with NHS recommendations) with a broader range of wound features assessed and documented. In evaluating improvements in recording information, three indicators were used. Ulcer size and type were recorded in 1993 on 2.2 per cent and 17.8 per cent of occasions respectively. By 1999 these had progressed to being recorded on 100 per cent of occasions. Assessments of ulcer edge also showed an improvement, being recorded on 11.1 per cent of occasions in 1993 and 50.6 per cent of occasions in 1999. The detail of record keeping allowed the data collection.

This study aims to design to assess the traditional, complementary and alternate medicine (TCAM) usage and its association with the quality of life (QOL) of Type 2 diabetic patients in a tertiary hospital (Hospital Universiti Sains Malaysia) in Malaysia.

A total of 300 respondents included in this study were divided into the following two major categories: TCAM (34.33% of respondents) and non-TCAM users (65.67% of the respondents), respectively. The mean ages of the respondents were 59.3 ± 10.2 for the TCAM users and 57.7 ± 12.0 for the non-TCAM users.

A greater percentage of non-TCAM users reported poor control of diabetes (14.7%) and blood glucose (55.8%) compared with the TCAM users (9.7% and 48.5%, respectively). Further, the diabetic patients on TCAM reported lower rates of coma, stroke and kidney problems but higher rates of diabetic foot ulcers, heart diseases and retinopathy than the non-TCAM users. Additionally, the diabetic patients with TCAM usage had a significantly better physical (p = 0.02) and overall (p = 0.03) qualities of life compared to the non-TCAM users. However, psychological, social and environmental health did not show any significant difference.

The prevalence of TCAM usage among diabetic patients was lower than in other comparable studies. Diabetic patients on TCAM reported lower rates of coma, stroke and kidney problems but higher rates of diabetic foot ulcers, heart diseases and retinopathy than the non-TCAM users. Further, diabetes patients on TCAM reported better QOL compared to non-TCAM users especially in terms of physical health.

This paper considers how the quality of wound care delivered to people experiencing mental ill health can be improved at the system level in line with the global focus on improving population health. The purpose of this paper is to identify how the quality of wound care delivered to mental health care service users can be improved at a population level through system thinking informed by boundary theory.

This paper is a critical analysis of practice underpinned by systems thinking and boundary theory.

Tissue viability care and mental health care have different professional cultures and identities that are manifest in the way that they are organised and deliver care. If improvements in wound care-related outcomes at a population level are to be achieved, then it is important that the wound care needs of people experiencing mental ill health are addressed. Systems thinking and boundary theory provide a useful conceptual framework for informing quality improvement for people experiencing mental ill health at a population level. Integrated care plans are a useful mechanism for delivering comprehensive care that brings about wound healing and recovery from mental ill health.

Integrated wound and mental health care plans transcend the professional boundaries that exist between tissue viability and mental health care services. Improvements in the quality and safety of care delivered to people with wounds who also utilise mental health services can be achieved through the use of integrated care plans. Health care policy and organisation need to meet the wound-related needs of people using mental health services.

There has been a focus on improving many aspects of wound care in line with the global focus on grand convergence in population health, but there has been very little emphasis on improving the wound-related outcomes of people that use mental health services. Systems thinking and boundary theory provide a useful framework for understanding how wound care for people experiencing mental ill health can be improved at a population level. Integrated care plans are a useful way of ensuring that safe high-quality wound care is consistently delivered to people experiencing mental ill health.

The purpose of this paper is to discuss the practical use of theoretical sampling as a method for selecting data that provide a richer and deeper understanding of the phenomenon being investigated.

Theoretical sampling is a well-known method in grounded theory studies to seek additional data based on concepts developed from initial data analysis. This method involves following where the data have led to expand and refine the evolving theory during the analytical process. However, there is a dearth of information detailing the practical steps needed to undertake theoretical sampling.

The authors used the theoretical sampling method in their study in four ways: asking additional interview questions and/or widening the scope of existing interview questions; recruiting participants with additional diversity of attributes within the same group; and adding a new group of participants and expanding research settings.

Theoretical sampling is a valuable and practical method for the purpose of addressing gaps in the data in qualitative research. When using theoretical sampling, it is essential to consider potential strategies for countering challenges that may arise. Practical recommendations are offered on the use of theoretical sampling during data analysis, for the purpose of achieving theoretical integration.

Real-time monitoring of wound or injured tissues is critical for speedy recovery, and the onset of a cascade of biochemical reactions provides potential biomarkers that facilitate the process of wound monitoring, e.g. pH, temperature, moisture level, bacterial load, cytokines, interleukins, etc. Among all the biomarkers, pH has been known to have a profound impact on the wound healing process, and is used to determine the incidence of bacterial infection of the wound (persistently elevated alkaline pH), proteolytic activity at the site of injury, take rate in skin grafting, wound healing stage and preparation for wound debridement.

This review highlights the significance of pH in determination of clinical parameters and for selection of an appropriate treatment regime, and it presents an in-depth analysis of the designs and fabrication methods that use integrated pH sensors, which have been reported to date for the real-time monitoring of wound healing.

For an expedited wound healing process, the significance of pH mandated the need of an integrated sensor system that would facilitate real-time monitoring of healing wounds and obviate the requirement of redressing or complicated testing procedures, which are both labor-intensive and painful for the patient. The review also discussed different types of sensor systems which were developed using hydrogel as a pH-responsive system coupled with voltammetry, potentiometry, impedimetric and flex-circuit inductive transducer systems. All of the mentioned devices have considerable potential for clinical applications, and there is need of in vivo testing to validate their efficiency and sensitivity under practical scenarios.

This manuscript is an original review of literature, and permission has been granted to use the figures from previously published papers.