A Free, Comprehensive Limb Preservation Owner’s Manual For Patients (and their docs) From @NealBarshes @BCM_Surgery – in 10 Languages

We can’t say enough about the great and good works of our SALSAmigo, Neil Barshes, the pride of Houston. On his github page, he has published what amounts to a soup-to-nuts owners manual for patients and their clinicians interested in limb preservation. Here it is, reprinted:

As an academic vascular surgeon, I work to develop cost-effective, resilient and equitable strategies to prevent leg amputations.

This contains a portfolio of resources I am sharing to help others interested in reducing the rate of leg amputations.

This two-page health policy brief, written with the University of Texas Medical Branch’s Center to Eliminate Health Disparities, summarizes the problems caused by leg amputations and suggests some steps forward.

Health professionals interested in getting overview of the spectrum of care to avoid leg amputations can read our 2013 “System of Care” review paper or our 2011 “framework” review paper. This 2019 “Advances in PAD” paper describes state-of-the-art developments in management.

Patient education brochures

Guard your Feet is a ~500 word brochure written to help persons at risk for foot ulcers and amputation with understanding how diabetes can lead to foot ulcers and infections and quantifying amputation risk. It helps people reduce their amputation risk, recognize a foot infection, and develop a contingency plan if infection does develop.

This brochure is written at the 8th grade level with minimal technical language and has been reviewed by patients. Fantastic colleagues here in Houston have helped translate it from English into nine other languages. Please feel free to download and distribute these brochures. Use them to start a conversation with your patients.

  1. Guard your Feet, English
  2. Proteja los Pies, Spanish
  3. Bảo vệ của bạn Đôi chân, Vietnamese
  4. Chebe ụkwụ gị, Igbo
  5. Shọ Ẹsẹ Rẹ, Yoruba
  6. گارڈ آپ پاؤں, Urdu
  7. حارس ك أقدام, Arabic
  8. आपके पेरोंकी रक्षा करे, Hindi
  9. Guarda dos seu Pes, Brazilian Portuguese
  10. 护理您的脚, Mandarin Chinese

Peer-Reviewed Manuscripts

  1. Foot ulcer prevention clearly represents to best opportunity for cost savings: reduced amputation rates + lower cost than current care.
  2. All patients with large or infected foot ulcers merit objective testing (toe pressures, skin perfusion pressures, or angiogram) to identify peripheral artery disease.
  3. Significant racial and ethnic disparities persist in Texas, as people categorized as Black and people categorized as Hispanic undergo higher risk-adjusted rates of leg amputations than people categorized as White.
  4. It can be cost-effective to offer revascularization and limb salvage efforts to elderly, functionally-marginal patients.
  5. Foot infections in bone (osteomyelitis) with E. coli or Pseudomonas are associated with worse outcomes; infections with methicillin-sensitive Staphylococcus aureus.

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