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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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              Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update)

              Diabetic foot disease results in a major global burden for patients and the health care system. The International Working Group on the Diabetic Foot (IWGDF) has been producing evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. In 2019, all IWGDF Guidelines have been updated based on systematic reviews of the literature and formulation of recommendations by multidisciplinary experts from all over the world. In this document, the IWGDF Practical Guidelines, we describe the basic principles of prevention, classification, and treatment of diabetic foot disease, based on the six IWGDF Guideline chapters. We also describe the organizational levels to successfully prevent and treat diabetic foot disease according to these principles and provide addenda to assist with foot screening. The information in these practical guidelines is aimed at the global community of health care professionals who are involved in the care of persons with diabetes. Many studies around the world support our belief that implementing these prevention and management principles is associated with a decrease in the frequency of diabetes-related lower extremity amputations. We hope that these updated practical guidelines continue to serve as reference document to aid health care providers in reducing the global burden of diabetic foot disease.
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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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