Browsing by Person "McArdle, Carla"

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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.
Effects of pH on the antibiotic resistance of bacteria recovered from diabetic foot ulcer fluid
(American Podiatric Medical Association, 2018-01-01) McArdle, Carla; Lagan, Katie M.; McDowell, David A.
Background: This study investigated the resistance of bacteria isolated from diabetic foot ulcers (DFUs) to antibiotics frequently used in the management of the diabetic foot infections, at a range of pH values (pH 6.5, 7.5, and 8.5) known to exist in DFU wound fluid. This study aimed to determine whether changes (or atypical stasis) in wound fluid pH modulate the antibiotic resistance of DFU isolates, with potential implications in relation to the suppression/eradication of bacterial infections in DFUs. Methods: Thirty bacterial isolates were recovered from DFU wound fluid, including Staphylococcus spp, Staphylococcus aureus, Escherichia coli, Streptococcus spp, Pseudomonas spp, and Pseudomonas aeruginosa. The resistances of these isolates to a panel of antibiotics currently used in the treatment of infected or potentially infected DFUs, ie, ciprofloxacin, amoxicillin-clavulanate, doxycycline, and piperacillin-tazobactam, at the previously mentioned pH values were determined by a modification of the Kirby-Bauer assay. Results: The resistance of DFU isolates to clinically relevant antibiotics was significantly affected by the pH levels in DFU wound fluid. Conclusions: These findings highlight the importance of a more comprehensive understanding of the conditions in DFUs to inform clinical decision making in the selection and application of antibiotics in treating these difficult-to-heal wounds. The scale of the differences in the efficacies of antibiotics at the different pH values examined is likely to be sufficient to suggest reconsideration of the antibiotics of choice in the treatment of DFU infection.
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.
The power of supervision (part one)
(Royal College of Podiatry, 2021) McIntyre, Joseph; McArdle, Carla; Santos, Derek
Supervision in action (part two)
(Royal College of Podiatry, 2022) McIntyre, Joseph; Downie, Allen; McArdle, Carla; Santos, Derek
The impact of wound pH on the antibacterial properties of Medical Grade Honey when applied to bacterial isolates present in common foot and ankle wounds. An in vitro study
(BioMed Central, 2023-10-02) McArdle, Carla; Coyle, Shirley; Santos, Derek
Background: Diabetic foot ulcers (DFUs) and post-surgical wound infections are amongst the most troublesome complications of diabetes and following foot and ankle surgery (FAS) respectively. Both have significant psychosocial and financial burden for both patients and the healthcare system. FAS has been reported to have higher than average post-surgical infections when compared to other orthopaedic subspecialties. Evidence also indicates that patients with diabetes and other co morbidities undergoing FAS are at a much greater risk of developing surgical site infections (SSIs). With the growing challenges of antibiotic resistance and the increasingly high numbers of resilient bacteria to said antibiotics, the need for alternative antimicrobial therapies has become critical. Aim: The aim of this study was to investigate the use of medical grade honey (MGH) when altered to environments typically present in foot and ankle wounds including DFUs and post-surgical wounds (pH6-8). Methods: MGH (Activon) was altered to pH 6, 7 and 8 and experimental inoculums of Pseudomonas aeruginosa (NCTC10782), Escherichia coli, (NCTC10418), Staphylococcus aureus (NCTC10655) and Staphylococcus epidermidis (NCTC 5955) were transferred into each pH adjusted MGH and TSB solution and the positive and negative controls. Results: MGH adjusted to various pH values had the ability to reduce bacteria cell survival in all pH variations for all bacteria tested, with the most bacterial reduction/elimination noted for Staphylococcus epidermidis. No correlations were noted among the pH environments investigated and the colony counts, for which there were small amounts of bacteria survived. Conclusion: This research would indicate that the antibacterial properties of honey remains the same regardless of the pH environment. MGH could therefore potentially be considered for use on non-infected foot and ankle wounds to reduce the bacterial bioburden, the risk of infections and ultimately to improve healing outcomes.
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.