Browsing by Person "Bullen, Benjamin"

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Charcot neuroarthropathy patient education among podiatrists in Scotland: a modified Delphi approach.
(BioMed Central, 2018-09-24) Bullen, Benjamin; Young, Matthew; McArdle, Carla; Ellis, Mairghread JH
Background This evaluation sought to determine current Charcot neuroarthropathy (CN) diabetes patient education practices among Scottish National Health Service (NHS) and academic podiatrists and evaluate novel visual tools and develop expert consensus for future practice. Methods Questionnaires collected mixed qualitative and quantitative responses, analysed concurrently within a convergence coding matrix. Delphi methodology permitted member-checking and agreement of consensus over two rounds. Results Fourteen participants (16.28%) completed a Round One questionnaire, leading to the generation of four themes; Experience; Person-Centred Care and the Content and Context of CN patient education. Seven consensus statements were subsequently developed and six achieved over 80% agreement among 16 participants (18.60%) with a Round Two questionnaire. Respondents agreed CN patient education should be considered for all ‘At-risk’ individuals with diabetic peripheral neuropathy (DPN). Verbal metaphors, including the ‘rocker-bottom’ foot, soft or brittle bones, collapsing, walking on honeycomb and a shattering lightbulb were frequently employed. Visual tools, including visual metaphors and The Charcot Foot Thermometer, were positively evaluated and made available online. Conclusions Key findings included respondent’s belief that CN education should be considered for all individuals with DPN and the frequent use of simile, analogy and metaphor in CN education. The concept of ‘remission’ proved controversial due to its potential for misinterpretation.
Closing the stable door after the horse has bolted: exploring Charcot foot health literacy among individuals with diabetic peripheral neuropathy in Scotland
(Queen Margaret University, Edinburgh, 2022) Bullen, Benjamin
Charcot foot is a potentially devastating complication of diabetic peripheral neuropathy (DPN). The frequently asymptomatic nature of this condition may lead to delayed recognition, diagnosis and pressure relief, associated with a characteristic ‘rocker bottom’ foot deformity. Deformity may, in turn, precipitate diabetic foot ulceration (DFU), infection and, ultimately, lower extremity amputation (LEA). Podiatric diabetes self-management education and support (DSMES) strategies have historically focused on DFU and LEA prevention, reserving Charcot foot information for those with ‘Active’ disease. The World Health Organisation defined health literacy (HL) as those personal traits and social support mechanisms required to understand and apply health information and access appropriate services. Specific traits and social support required to recognise and respond to early Charcot ‘danger signs’ were defined as ‘Charcot foot health literacy’ (CFHL). A resultant ‘Charcot foot health literacy conundrum’ was proposed, as individuals with DPN, ‘At-risk’ of Charcot foot, were not informed of their risk status nor did they receive targeted education or support. The research hypothesis was that individuals with Charcot foot experience, classified as ‘In Remission,’ developed specific CFHL traits through exposure to podiatric DSMES and reflection on past experience. This pragmatic, mixed methods research compared general, multidimensional HL and ‘Knowledge,’ ‘Understanding’ and ‘Contextualisation’ CFHL skills between people with and without Charcot foot experience, with the Health Literacy Questionnaire and a novel CCHAIR Study Qualitative Questionnaire, respectively. Study findings confirmed ‘At-risk’ individuals lacked Charcot foot knowledge. All participants more readily associated this condition with late-stage complications, rather than early inflammatory signs. Charcot foot experience was associated with active self-management and those ‘In Remission’ remained engaged with specialist podiatry and/or multidisciplinary services. Future DSMES approaches should target all individuals with DPN, focusing on prompt self-recognition of, and self-referral in the event of, Charcot foot ‘danger signs.’
Here we go again: remission and re-ulceration in the diabetic foot
(SB Communications, 2018-04-25) Bullen, Benjamin; Young, Matthew; McArdle, Carla; Ellis, Mairghread JH
A case report of an individual presenting with a self-inflicted diabetes foot ulcer following inappropriate over-the-counter corn plaster use was published in the October 2016 issue of this journal (Bullen and Young, 2016). The role of low health literacy was discussed in order to optimise diabetes foot education. This update documents recurrent ulceration 1 year following initial presentation, illustrating a need for ongoing, personalised diabetes foot education for those ‘in remission’ from foot disease. The importance of patient recognition of the signs and symptoms of benign hyperkeratotic lesions and active diabetes foot disease is discussed, facilitating early presentation to podiatry services and prevention of further complications.
It’s time we talked about Charcot foot: Results of a podiatry patient education questionnaire
(Wounds Group, 2019-09-01) Bullen, Benjamin; Young, Matthew; McArdle, Carla; Ellis, Mairghread JH
In contrast with diabetic foot ulceration (DFU) and lower-extremity amputation (LEA), current Scottish patient information leaflets reserve Charcot foot education for individuals ‘In Remission’ from, or with active, Charcot foot. A small group of Scottish NHS podiatrists recently agreed Charcot foot education should be delivered to all ‘At-risk’ individuals with diabetic peripheral neuropathy. This study sought to compare discussion about diabetes foot disease and Charcot foot between ‘At-risk’ and ‘In Remission’ groups among this cohort. Fourteen participants completed an ‘At-risk’ component of the Charcot foot patient education questionnaire, while six also completed an ‘In Remission’ component. Topics investigated for both groups included DFU and LEA risk, footwear and insoles, and signs of infection and Charcot foot. Frequency of discussion data was captured with a five-point Likert scale. Median response and interquartile range (IQR) were described and compared between groups. Median values and IQR for discussion of DFU and LEA risk were 5 (IQR 1) and 3 (IQR 1.25) respectively for ‘At-risk’ groups, and 5 (IQR 0.25) and 3 (IQR 2), respectively, among the ‘In Remission’ group. For discussion of footwear and insoles, the median response was 4 (IQR 1) for ‘At-risk’ and 5 (IQR 1) for ‘In Remission’ groups, reversed for discussion of signs of infection. The greatest between-group discrepancy was found for discussion of Charcot foot, with median responses and IQR found to be 3 (IQR 2) and 5 (IQR 0.25) for ‘At-risk’ and ‘In Remission’ groups, respectively. This discrepancy has potential implications for Charcot foot educational strategies, audit and research. It is proposed that ‘always’ should be the benchmark for frequency of Charcot foot education, not just for those ‘In Remission’ but also those ‘At risk’.
Overcoming barriers to self-management: The person-centred diabetes foot behavioural agreement
(Elsevier, 2019-01-11) Bullen, Benjamin; Young, Matthew; McArdle, Carla; Ellis, Mairghread JH
Objective - Behavioural agreements have been proposed as a clinical strategy for improving concordance with diabetes foot self-management practices, both for individuals ‘At-risk’ of, and with active, diabetes foot disease. This narrative review sought to explore the potential supportive role of person-centred diabetes foot behavioural agreements in promoting protective foot self-management behaviours among ‘At-risk’ individuals. Conclusions - Health care professionals (HCPs) involved in diabetes foot risk stratification and management dedicate considerable time, effort and resources to the prevention of diabetic foot ulcers (DFU) and lower extremity amputation (LEA) and are uniquely placed to deliver person-centred diabetes self-management education and support (DSMES) interventions. Written, verbal and non-verbal agreements are consistent with a wider global move toward DSMES approaches, respectful of people’s preferences, and supporting them to undertake protective self-care behaviours. Practice implications - It is theorised that clear communication of the roles of the person with diabetes, their family or carers and HCPs may improve concordance with self-management behaviours. Rather than a punitive measure or means of facilitating discharge of ‘non-concordant’ individuals, person-centred behavioural agreements should be framed positively, as a means of delineating, prescribing and supporting individual diabetes foot-care responsibilities. This is an area worthy of further research.
Visual and kinaesthetic approaches to pragmatic, person-centred diabetic foot education
(Wounds Group, 2017-02-28) Bullen, Benjamin; Young, Matthew; McArdle, Carla; Ellis, Mairghread JH
This review of clinical practice describes a pragmatic, person-centred approach to diabetic foot education that is sensitive to individual adult service users' learning needs and preferences. National clinical guidance recommends foot education for all people with diabetes in the UK. Evidence for the effectiveness of foot education remains limited, particularly concerning long-term behaviour modification and the prevention of ulceration and amputation. The Scottish Diabetes Foot Action Group produces written diabetic foot information and advice leaflets to support verbal patient education, but this approach may not be suitable for all. Individuals with low health literacy and visual or kinaesthetic learning preferences should also be considered. Readily-available, cost-effective and expedient strategies for inclusive diabetic foot education are presented in this article.
When patient education fails: do we consider the impact of low health literacy?
(SB Communications, 2016-09-23) Bullen, Benjamin; Young, Matthew
Diabetes foot education concerning foot care knowledge and appropriate self-care behaviours is considered vital in the prevention of diabetes foot ulceration. Verbal education and advice should be issued and reinforced at each patient intervention to improve patient's knowledge and self-care behaviours. Written education materials have been developed in Scotland to standardise the information patients receive. Despite standardised written and verbal advice, many patients continue to develop preventable foot ulcers. This case study describes one such instance of self-induced diabetes foot ulceration secondary to the application of an over-the-counter corn remedy and considers whether poor health literacy contributed to this adverse outcome.