{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:23:14Z","timestamp":1793726594206,"version":"4.6.1"},"reference-count":23,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluated the toe and flow model (TFM), a limb preservation program led by podiatric surgeons in Alberta, Canada, for its impact on hospitalization rates and length of stay (LOS) in patients with diabetic foot complication (DFC). Diabetes, a leading cause of non-traumatic lower extremity amputations (LEAs) in Canada, often results in diabetic foot ulcers (DFUs), a major cause of infection, amputation, and hospitalization. TFM has reportedly reduced amputation rates by 39% to 56%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The study analyzed Alberta's health database from 2007 to 2017, focusing on diabetes patients aged 20 and above. It included patients with various DFCs and compared outcomes in regions using TFM and standard of care (SOC). The study also examined data from two major cities, one with TFM and the other without, including rural referrals to Calgary and Edmonton. The data were normalized for the diabetic population and analyzed using a standard Student\u2019s\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      TFM regions showed significantly lower hospitalization rates (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20091.22E-12) than SOC regions. Over 11 years, TFM maintained lower average and median LOS by 0.13 and 0.26 days, respectively. TFM access reduced hospitalization risk by up to 30%, and patients in TFM regions had a 21% shorter LOS compared to SOC regions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite similar demographics and healthcare systems, the TFM region benefited from a dedicated multidisciplinary program and comprehensive limb preservation services. The study shows that TFM effectively reduces hospitalizations and LOS for DFCs, with significantly better outcomes in the TFM region than in SOC regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15347346241238458","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T03:44:20Z","timestamp":1710906260000},"page":"117-123","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Effectiveness of a Multidisciplinary Limb Preservation Program in Reducing Regional Hospitalization Rates for Patients With Diabetes-Related Foot Complications"],"prefix":"10.1177","volume":"24","author":[{"given":"Ali","family":"Manji","sequence":"first","affiliation":[{"name":"Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada"},{"name":"Cumming School of Medicine, University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0209-6478","authenticated-orcid":false,"given":"Reza","family":"Basiri","sequence":"additional","affiliation":[{"name":"Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada"},{"name":"Institute of Biomedical Engineering, University of Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Harton","sequence":"additional","affiliation":[{"name":"Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada"},{"name":"Cumming School of Medicine, University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenton","family":"Rommens","sequence":"additional","affiliation":[{"name":"Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada"},{"name":"Cumming School of Medicine, University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Manji","sequence":"additional","affiliation":[{"name":"Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada"},{"name":"Cumming School of Medicine, University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2008.1074"},{"key":"e_1_3_2_3_2","unstructured":"New diabetes rates released with urgent plea for governments to implement national diabetes strategy. Diabetes Canada. Published 2020. Accessed November 15 2020. https:\/\/www.diabetes.ca\/media-room\/press-releases\/new-diabetes-rates-released-with-urgent-plea-for-governments-to-implement-national-diabetes-strategy"},{"key":"e_1_3_2_4_2","unstructured":"Amputation prevention. Diabetes Canada. Published 2020. Accessed November 15 2020. https:\/\/www.diabetes.ca\/advocacy---policies\/our-policy-positions\/amputation-prevention"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.190134"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12391"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/1520-7560(200009\/10)16:1 <::AID-DMRR139>3.0.CO;2-8"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.2.217"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2020.07.086"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13047-020-0380-8"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107996"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.06.004"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.7547\/19-137"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.08.244"},{"issue":"12","key":"e_1_3_2_15_2","first-page":"1","article-title":"Protocol for metadata and image collection at diabetic foot ulcer clinics: enabling research in wound analytics and deep learning","volume":"23","author":"Basiri R","year":"2024","unstructured":"Basiri R, Manji K, LeLievre PM, et al. Protocol for metadata and image collection at diabetic foot ulcer clinics: enabling research in wound analytics and deep learning. BioMed Eng OnLine. 2024;23(12):1-8. doi: https:\/\/doi.org\/10.1186\/s12938-024-01210-6","journal-title":"BioMed Eng OnLine"},{"key":"e_1_3_2_16_2","unstructured":"Basiri R Manji K Harton F Poonja A Popovic MR Khan SS. Synthesizing diabetic foot ulcer images with diffusion model. arXiv preprint. Posted online October 20 2023. arXiv:2310.20140."},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.04.010"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1159\/000452746"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semvascsurg.2021.02.011"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S251236"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2005.02.010"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.33.1.07"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-0687-5"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/1708538120923420"}],"container-title":["The International Journal of Lower Extremity Wounds"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346241238458","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15347346241238458","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346241238458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:05:13Z","timestamp":1777457113000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15347346241238458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,20]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1177\/15347346241238458"],"URL":"https:\/\/doi.org\/10.1177\/15347346241238458","relation":{},"ISSN":["1534-7346","1552-6941"],"issn-type":[{"value":"1534-7346","type":"print"},{"value":"1552-6941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,20]]}}}