Clinical Briefs



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Am Fam Physician. 2001 Mar 1;63(5):981-982.

Clinical Guidelines on Diabetic Foot Disorders

The American College of Foot and Ankle Surgeons (ACFAS) has published clinical practice guidelines on the diagnosis and treatment of diabetic foot disorders. The guidelines, titled “Diabetic Foot Disorders: A Clinical Practice Guideline,” appear as a supplement to the October 2000 issue of The Journal of Foot and Ankle Surgery.

In the United States, an estimated 800,000 new cases of foot ulcers occur every year and 86,000 patients with diabetes undergo foot amputations. Diabetic ulcers are the main reasons for lower extremity amputations, according to the ACFAS guidelines. Foot problems caused by complications of diabetes are the leading cause of hospitalizations of patients with diabetes. An estimated 15 percent of these patients experience a serious foot problem sometime in their lives.

The ACFAS guidelines are designed to improve understanding of the causes of diabetic foot problems and provide information about new treatments for foot ulcers and other diabetic foot conditions. The guidelines recommend that physicians examine their patients' feet during every office visit. Patients should be asked to remove their shoes and socks in the examining room so physicians can inspect their feet to help prevent foot ulcers or catch them at early stages.

The guidelines provide information about new treatments for managing foot ulcers, such as growth factors and skin substitutes that can expedite healing. They also encourage every health care professional to watch for the warning signs of foot disorders and take appropriate action before further complications occur.

FDA Approves the Use of Oseltamivir in Children

The U.S. Food and Drug Administration (FDA) has approved a new pediatric indication for oseltamivir (Tamiflu). The medication may now be used for the treatment of acute illness caused by influenza in children one year and older who have been symptomatic for no more than two days.

In pediatric clinical studies, oseltamivir was well tolerated, according to the manufacturer. When given within two days of the onset of symptoms, oseltamivir reduced the duration of influenza by 1.5 days (26 percent) in patients one to 12 years of age. Duration of influenza was defined as time to the alleviation of cough, nasal congestion, fever resolution and parental opinion of return to normal health and activity.

Oseltamivir is available in a tutti-frutti flavored liquid suspension for pediatric patients and may also be used in adults who are unable to swallow a capsule. The most common side effect in children treated with oseltamivir was vomiting. Other side effects included abdominal pain, epistaxis, ear disorder and conjunctivitis. In clinical studies, these adverse events occurred only once, despite continued dosing.

Oseltamivir has not been shown to prevent serious bacterial infections that may begin with influenza-like symptoms or may co-exist with or occur as complications during the course of influenza.

The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention stresses that oseltamivir is not a replacement for vaccination and recommends early vaccination on a yearly basis, unless vaccination is contraindicated, unavailable or not feasible.

Scientific Exhibit Deadline for AAFP Assembly

A call for scientific exhibits has been issued by the American Academy of Family Physicians (AAFP) for possible presentation at the 2001 Scientific Assembly occurring October 3–7, 2001, in Atlanta. Applications must be submitted by April 6, 2001. Membership in the AAFP is not a prerequisite for submission. Scientific exhibits provide a forum for the presentation of research that is of interest and educational value to family physicians. The exhibits include those presented by residents and medical students.

Travel grants of $1,000 may be awarded to a maximum of 15 resident/student scientific exhibitors whose applications are accepted for presentation at the assembly. In addition, cash awards for first, second, third and fourth places may be presented to resident/student exhibitors. Application forms may be obtained from Vicky Binder, Scientific Program Department, AAFP, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211; telephone: 800-274-2237, ext. 6564; or by visiting the AAFP Web site at http://www.aafp.org/assembly/research.

Risk of Driving in Patients with Alzheimer's Disease

The American Academy of Neurology (AAN) has issued guidelines to help determine whether persons with Alzheimer's disease should continue to drive motor vehicles. The guidelines appear in the June 27, 2000 issue of Neurology.

Researchers searched medical databases and literature for scientific studies on Alzheimer's disease and driving. They found 14 relevant studies in the following categories: studies that examined the rate of motor vehicle crashes in drivers with Alzheimer's disease, studies that involved on-the-road or simulated performance tests, and studies that evaluated how well persons with Alzheimer's disease can process what they see when driving.

The researchers compared the risks of driving for persons with Alzheimer's disease with the risks found in other groups of drivers, such as 16- to 21-year-old persons or persons driving under the influence of alcohol but within the legal limit.

The AAN makes the following recommendations:

  • Persons with mild Alzheimer's disease should not drive. Mild Alzheimer's disease is characterized by moderate memory loss that is more noticeable for recent events and interferes with everyday activities. It also involves mild but definite impairment of functioning at home, where patients stop doing more difficult chores and lose interest in their more complicated hobbies. However, they are still capable of personal care, but need prompting to do so.

  • Evaluations of driving performance should be considered for persons with slight cognitive impairment. This means slight forgetfulness that does not interfere with everyday activities. There is slight impairment in home activities and hobbies. These patients are fully capable of handling their personal care.

Patients with slight impairment also have an increased risk of motor vehicle crashes when compared with other elderly drivers, but their risk is similar to that of 16 to 21 year olds or to drivers with blood alcohol levels of less than 0.8.

  • Patients with mild Alzheimer's disease should be reassessed every six months because of the likelihood of increased dementia within a few years.

  • More research should be done on patients with mild Alzheimer's disease and on the type and severity of motor vehicle crashes in which these patients are drivers.

Call for Papers of Family Practice Research Presentations

A call for papers has been issued by the American Academy of Family Physicians (AAFP) for possible presentation at the 2001 Scientific Assembly occurring October 3–7, 2001, in Atlanta. Applications must be submitted by April 2, 2001. Membership in the AAFP is not a prerequisite for submission.

Applications may be submitted in two different categories. Category I is for original research relevant to family practice; Category II includes case studies and literature reviews. Each category has six author classifications: family physicians and fellows primarily in academic medicine, family physicians primarily in clinical practice, family practice residents, medical students, international attendees and others. The international attendee classification is open to anyone outside the United States who conducted clinical or educational research relevant to family medicine.

Up to six first place winners in Category I and one first place winner in Category II will each receive a cash award of $1,000. Up to six runners-up in Category I and one runner-up in Category II will receive $250 cash awards. All awards are given at the discretion of the Subcommittee on Family Practice Research Presentations. Application forms may be obtained from Carrie Vickers, Scientific Program Department, AAFP, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211; telephone: 800-274-2237, ext. 6568; or by visiting the AAFP Web site at http://www.aafp.org/assembly/abstract.


Copyright © 2001 by the American Academy of Family Physicians.
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