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Response to the article: Progression of disease preceding lower extremity amputation in Denmark: a longitudinal registry study of diagnoses, use of medication and healthcare services 14 years prior to amputation.
This article presents an impressive 14 year-long longitudinal study demonstrating the crucial importance of identifying and understanding the progression of lower extremity amputation (LEA)- related diseases. In doing so, health care providers are better prepared to address and potentially eliminate contributing risk factors. As mentioned by the researchers, only a few previous studies have inquired about the progression of diseases and use of health care services related to lower extremity amputations using historical longitudinal data.
I personally found this article extremely interesting and very well detailed regarding patient demographics, comorbidities, prevalence of prescribed medication, and contacts made to hospitals and general practitioners (GPs). I particularly liked the strong emphasis made on the importance of disease prevention and early symptom recognition in order to treat patients earlier and avert complications.
What did stand out to me, however, was that a significant portion of the sample had low education in regards to years of schooling. 88% of the sample had less than 9 years of school education which makes me question if educational status played a more significant role in disease progression than what was mentioned...
What did stand out to me, however, was that a significant portion of the sample had low education in regards to years of schooling. 88% of the sample had less than 9 years of school education which makes me question if educational status played a more significant role in disease progression than what was mentioned in the article. Though the majority of the sample did have contact with a hospital or GP, without proper knowledge and information related to an illness, patients are not able to self-recognize symptoms and/or risk factors. Unless directly asked or addressed by a GP, neuropathy, an evident symptom of potential diabetes, can go missed by the patient.
As a nurse, I can appreciate the impact of undiagnosed and untreated risks related to LEA on the part of the healthcare worker, but I also believe that patient-related risks such as low education need to be considered closely. As mentioned in Berkman et al.’s (2011) systematic review, low health literacy is directly related to poorer health outcomes. With knowledge comes power. If patients have the tools and resources necessary to self-identify symptoms and risk factors, they are in a better position to self-advocate and ensure adequate treatment and follow-up. This idea is also in line with the value of shared health responsibility on the part of the patient and the healthcare worker.
Realizing and acknowledging that health and disease progression are not static in nature, I want to congratulate the researchers on this intriguing 14 year-long longitudinal study.
Berkman, N.D., Sherldan, S.L., Donahue, K.E., Halpern, D.J., Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medecine. 155(2), 97-107.
Jensen PS, Petersen J, Kirketerp-Møller K, et al. Progression of disease preceding lower extremity amputation in Denmark: a longitudinal registry study of diagnoses, use of medication and healthcare services 14 years prior to amputation. BMJOpen 2017;7:e016030. doi: 10.1136/bmjopen-2017-016030