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Doppler is the most commonly utilised vascular assessment tool by podiatrists in Australia and the United Kingdom. Doppler is a key component of many international guidelines for vascular assessment. Used alongside pressure measurements such as ankle and toe-brachial indices, Doppler assists podiatrists to diagnose, triage and subsequently manage patients with peripheral arterial disease. This commentary aims to clarify the importance, technique, and interpretation of continuous wave handheld Doppler in podiatry practice. This commentary presents discussion on the equipment and optimal test conditions for use of Doppler, and guidance on the technique required in podiatry clinical practice. Furthermore, there is a focus on interpretation of the output from Doppler including both audio and visual output. There is in depth discussion about identifying pathology and integration into the clinical management plan. [ABSTRACT FROM AUTHOR]

Background: Peripheral arterial disease (PAD) is a common condition that causes significant morbidity and reduced life expectancy, and can have a serious economic impact. It is often underdiagnosed in primary care, partially due to the fact that the current National Institute for Health Care and Excellence-recommended ankle-brachial pressure index (ABPI) test for PAD in primary care is time-consuming and is technically challenging to perform. The availability of a simple, reliable diagnostic test has the potential to facilitate early PAD identification and treatment. Objective: The aim of this study was to evaluate the preferences of primary care practitioners relating to the key characteristics for a new medical device for PAD detection. Participants: A sample of 116 UK primary care setting clinicians involved in the diagnosis and/or management of PAD, comprising of doctors (n = 95), nurses (n = 17), health care assistants (n = 1) and other unspecified clinicians (n = 3). Outcomes: Relative weights derived from a discrete choice experiment (DCE), by primary care practitioners regarding six key characteristics of the new device: device display, data integration, training, power supply, portability of the device, and cost. Results: Five characteristics were important for preferences. Practitioners favoured manual, as opposed to automated, integration of test results into patient records. Practitioners strongly preferred disposable batteries as the power supply for the device compared with other alternatives. Conclusions: This novel study has successfully utilised a DCE to elicit primary care practitioner's preferences for the development of the new device. The preferences can help inform device design and therefore facilitate/help to maximise its uptake and buy-in from the outset. [ABSTRACT FROM AUTHOR]

Accurate and timely diagnosis of leg ulceration is an essential factor in making evidence-based, effective decisions regarding patient management with the aim of swift wound healing and/or referral to the appropriate specialty. Nurses are professionally responsible for ensuring that patients receive the appropriate assessment and evidence-based management. This article examines the most up-to-date guidance on Doppler ultrasound as a key element of this assessment. Approaches to assessment will be explored, with emphasis on the need to include a Doppler ultrasound as one key element of a larger, holistic assessment. An introduction to the ankle–brachial pressure index (ABPI) will be given, followed by a step-by-step guide to standard procedures for carrying out a full Doppler ultrasound. Alternative options for measuring ABPI are also provided. [ABSTRACT FROM AUTHOR]

Objectives. Digital ischaemia, often progressing beyond RP to digital ulceration and sometimes even gangrene, is the most common vascular manifestation of SSc. Both microvascular and macrovascular disease can contribute and coexistence of microvascular and macrovascular (proximal vessel) disease in patients with SSc is potentially limb threatening. The aims of this study were to examine the change over time in the ankle brachial pressure index (ABPI) in a cohort of patients with SSc and to examine whether age, gender, smoking status, disease duration, disease subtype and ACA are associated with ABPI.Methods. The clinical and laboratory data of 217 patients attending the SSc clinic at a tertiary referral centre and who had their ABPIs checked between 1996 and 2011 were reviewed retrospectively. Data were analysed to see how the ABPI changed with time and linear mixed effects modelling was used to determine which factors were associated with ABPI.Results. In most patients with SSc, the ABPI remained constant over time [median rate of change 0 units/year, interquartile range (IQR) −0.01–0.01]. There was a significant association between lower ABPI and increasing age (P = 0.04), the limited cutaneous subtype of SSc (P = 0.01) and ACA positivity (P = 0.03). Additionally there was an association between ABPI and smoking status of borderline statistical significance (P = 0.08).Conclusion. This study provides further evidence for associations between the severity of vascular disease in patients with SSc and increasing age, smoking, limited cutaneous disease and positive ACA. Reassuringly, in most patients ABPI remains stable over time. [ABSTRACT FROM PUBLISHER]

Objective. To evaluate the prevalence of abnormal pulse wave velocity (PWV), pulse contour analysis (PCA) and abnormal ankle–brachial pressure index (ABPI) in patients with livedo reticularis (livedo) and without livedo.Methods. We recruited 74 patients, of whom 41 had livedo: 16 APS, 9 APS with SLE and 16 with livedo (negative for aPL or lupus). The other group of 33 patients without livedo consisted of 10 APS, 8 APS with SLE and 15 with SLE only. Livedo was diagnosed and confirmed by a dermatologist. PWV was assessed in fasting patients by the Micro Medical PulseTrace analyser using a 4 MHz continuous-wave directional Doppler probe and digital PCA was analysed by Micro Medical PulseTrace by the same operator. Chi-square with Yates’s correction was used for comparing results.Results. The median age of the livedo patients was 46 (29–71) years and of the non-livedo patients was 45 (25–68) years. Abnormal values of PWV in 10/41 (24.40%), ABPI in 4/41 (9.8%) and PCA in 10/41 (24.40%) patients were observed in the livedo group and in the non-livedo group abnormal values of PWV in 1/33 (P ≤ 0.025), ABPI in 0/33 (P = NS) and PCA in 5/33 (P = NS) were observed.Conclusion. Patients with livedo reticularis are more likely to have abnormal PWV, indicating arterial stiffness. [ABSTRACT FROM PUBLISHER]

Clinicians are expected to show improved healing rates, reduction in recurrence rates and to demonstrate greater patient satisfaction. All patients should rightly expect a high standard of holistic care that supports both their physical and emotional needs. Keeping the patient engaged in the 'healing process' has many beneficial outcomes, not least to their emotional wellbeing. Managing to heal the wounds within a realistic timeframe is the required outcome for all parties. This article demonstrates how a new compression device, Juxta CURES, has a positive impact on patients' quality of life, also benefiting the clinician while maintaining cost-saving efficiencies. [ABSTRACT FROM AUTHOR]

Peripheral vascular disease (PVD) is under-diagnosed in primary and acute settings. The use of Doppler ankle brachial pressure index (ABPI) is effective in diagnosing PVD , aid in determining aetiology of leg ulcers and is cost efficient in reducing the effects of atherosclerosis and M cardiovascular events. The aim of this literature review was to review practitioners' experience in using Doppler ABPI, different skills used to measure ABPI and to examine practitioners' confidence in ABPI. The findings identified variation in method for Doppler measurement: including position of the artery, arm measurement, resting period and type of equipment for measuring blood pressure, variations in practitioners' training and experience have demonstrated variability in ABPI results. Although limited in number, the studies have demonstrated knowledge gap, and the need for training among health professionals. [ABSTRACT FROM AUTHOR]

The association between novel atherosclerotic risk biomarkers and severity of peripheral arterial disease (PAD) was assessed. Patients (n = 133) with PAD were recruited. Established risk biomarkers including low- and high-density cholesterol, triglycerides, and blood pressure were measured. Novel risk biomarkers including plasma C-reactive protein, von Willebrand factor (vWF), interleukin 6, red cell folate (RCF), vitamin B12, total homocysteine (tHcy), and Hcy genotypes were also determined. The severity of PAD was evaluated, using ankle—brachial pressure index (ABPI), brachial—knee, and brachial—ankle pulse wave velocity (bk- and ba-PWV). Plasma tHcy and systolic blood pressure had a positive independent correlation with bk-PWV (β = +0.56, P = .02 and β = +0.38, P < .001, respectively). Red cell folate had an independent inverse correlation with bk-PWV (β = —0.01, P = .01). Systolic blood pressure showed an independent positive correlation with ba-PWV only after adjustment for other risk biomarkers (β = +0.1, P = .04). Novel markers, plasma tHcy, and RCF levels correlated with the severity of PAD. [ABSTRACT FROM PUBLISHER]

The article discusses a negative pressure wound therapy workshop which was conducted by nurse Jeannette Milne as part of the Wound Expo 2017 event, and it mentions the burden of chronic wound treatments, nurse-patient relations, and the British National Health Service (NHS) agency. Wound healing and patient reassessments are addressed, along with alternative medical treatments for wounds. Wound infection treatment and surgical flaps and grafts are examined.

The author reflects on medical care in Great Britain, the ankle brachial pressure index (ABPI), and the claim that nurses should not view patients as numbers. According to the article, healthcare assistants are becoming more involved in patient wound care and the treatment of patients with leg ulcers. Decision making in medicine is examined, along with delays in diagnosing and managing patients' medical problems. Ulcer management education and experience are assessed.