{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T05:06:46Z","timestamp":1792300006884,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,10,11]],"date-time":"2017-10-11T00:00:00Z","timestamp":1507680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"South-West Regional Cardiovascular Disease Network"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To investigate the relationship between high diabetes\u2010related lower limb amputation incidence and foot care services in the South\u2010West region of England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The introduction of 10 key elements of foot care service provision in one area of the South\u2010West resulted in stabilization of foot ulcer incidence and sustained reduction in amputation incidence from 2007. Services introduced included administrative support, standardized general practice foot screening, improved community podiatry staffing, hospital multidisciplinary foot clinics, effective care pathways, availability of an orthotist and audit. Peer reviews of the region's diabetes foot care services were undertaken to assess delivery of these service provisions and compare this with major amputation incidence in other regions with data provided by Yorkshire and Humber Public Health Observatory Hospital Episode Statistics. Recommendations were made to improve service provision. In 2015 changes in service provision and amputation incidence were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Initial reviews in 2013 showed that the 3\u2010year diabetes\u2010related major amputation incidence correlated inversely with adequate delivery of diabetes foot care services (<jats:italic>P<\/jats:italic>=0.0024, adjusted <jats:italic>R<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup> =0.51). Repeat reviews in 2015 found that two or more foot care service improvements were reported by six diabetes foot care providers, with improvement in outcomes. The negative relationship between major amputation incidence and service provision remained strong both in the period 2012\u20132015 and in the year 2015 only (<jats:italic>P<\/jats:italic> \u22640.0012, adjusted <jats:italic>R<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup> =0.56, and <jats:italic>P<\/jats:italic>= 0.0005, <jats:italic>R<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>=0.62, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Major diabetes\u2010related lower limb amputation incidence is significantly inversely correlated with foot care services provision. Introduction of more effective service provision resulted in significant reductions in major amputation incidence within 2 years. Failure to improve unsatisfactory service provision resulted in continued high amputation incidence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.13512","type":"journal-article","created":{"date-parts":[[2017,10,11]],"date-time":"2017-10-11T09:46:43Z","timestamp":1507715203000},"page":"53-62","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":97,"title":["Diabetes\u2010related major lower limb amputation incidence is strongly related to diabetic foot service provision and improves with enhancement of services: peer review of the South\u2010West of England"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7790-2569","authenticated-orcid":false,"given":"R. B.","family":"Paisey","sequence":"first","affiliation":[{"name":"Horizon Centre Torbay Hospital Torbay and South Devon NHS Foundation Trust Lawes Bridge Torquay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Abbott","sequence":"additional","affiliation":[{"name":"Department of Podiatry, Torbay and South Devon NHS Foundation Trust Torquay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Levenson","sequence":"additional","affiliation":[{"name":"Cardiovascular Strategic Clinical Network South Plaza, Marlborough Street Bristol"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Harrington","sequence":"additional","affiliation":[{"name":"Department of Podiatry Gloucestershire Care Services NHS Trust Gloucester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Browne","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospital Treliske Truro UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Moore","sequence":"additional","affiliation":[{"name":"Cardiovascular Strategic Clinical Network South Plaza, Marlborough Street Bristol"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Bamford","sequence":"additional","affiliation":[{"name":"Cardiovascular Strategic Clinical Network South Plaza, Marlborough Street Bristol"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Roe","sequence":"additional","affiliation":[{"name":"Cardiovascular Strategic Clinical Network South Plaza, Marlborough Street Bristol"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the South\u2010West Cardiovascular Strategic Clinical Network peer diabetic foot service review team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00400697"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1056-8727(03)00071-0"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-1108"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.8.1433"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2013.02.014"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.1994.tb00310.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-012-2468-6"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2007.02189.x"},{"key":"e_1_2_9_10_1","unstructured":"Yorkshire and Humber Public Health Observatory YHPHO.Diabetes footcare activity profiles. 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