Clinical resources for diabetic foot health: applying the Wounds Canada Foot Health Pathway in Newfoundland and Labrador
Bibliographic record
Abstract
Background: Newfoundland and Labrador (NL) has one of the highest incidences of diabetes and diabetes-related lower-limb amputations (LLAs) in the country, which has long-term implications for patients, families, health care providers (HCPs) and health systems. Despite the widespread prevalence of LLAs in NL, an organizational-level approach to address diabetic foot management is lacking. The aim of this practicum project was to develop a comprehensive clinical resource for HCPs to reduce diabetic foot complications and improve outcomes for patients living with diabetes in NL. Methods: Integrated literature review, consultations with key informants, environmental scan to determine existing resources, and development of a joint clinical resource for diabetic foot health. Results: The literature supported that diabetic foot ulceration (DFU) and LLA is a problem with negative implications for patients, HCPs and health systems and provided evidence in support of clinical pathways (CPWs) as an organizational level strategy to address DFU. The environmental scan illuminated the widespread availability of CPWs in jurisdictions outside of NL and highlighted the usefulness of the CPW developed by Wounds Canada in directing the provision of care. The consultation phase shed light on the complexity of diabetic foot management and allowed for the identification of specific needs of HCPs within a local context. Cumulatively, these findings informed the development of a clinical resource for the diabetic foot that aligns with evidence-based practice and the local needs of providers. An infographic was developed for local HCPs to support the application of the Wounds Canada (2022) Foot Health Pathway for People Living with Diabetes. The Wounds Canada CPW is designed to assist HCPs to systematically prevent, screen, detect, and treat diabetic foot concerns based on assessment of risk. A custom button was also developed as a secondary strategy to improve foot screening on an individual-level. Conclusion: A joint organizational and individual level strategy consisting of an infographic tailored to the local context of NL and a custom button for providers may be effective in assisting HCPs with application of the Wounds Canada CPW and in turn, improve diabetes outcomes in the NL. Key terms: Diabetes, diabetic foot ulcers, lower-limb amputations, care pathway, health care provider, management, organizational-level, individual-level, quality improvement, infographic, button.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.029 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.007 | 0.002 |
| Scholarly communication | 0.008 | 0.003 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".