 |
Interdisciplinary Leg Initiative 25-26 October 2008 Imperial College, London Uk |
WATCH ONLINE NOW! |
ilegx hosts the first interdisciplinary consensus summit addressing definitions, diagnosis, prevention and definitive management of leg/foot tissue loss covering all vascular and non-vascular causes.
The Review
The ilegx initiative was launched at Imperial College with an inaugural meeting at 25-26th October 2008. The initiative took place under the organisation of BIBA Medical which runs the Charing Cross Symposium series. However, it was very much the creation of three interdisciplinary programme directors, Dr Michael Edmonds, diabetologist, of Kings College Hospital in London, Dr Dieter Mayer, vascular surgeon and wound care expert , Zurich, Switzerland and Professor Gunnar Tepe, interventional radiologist, Tubingen, Germany.
From the medical point of view, I became supportive of this concept, when, to my horror, I realized, that I had led a Regional Vascular Service in West London for some 25 years and the amputation rate is still rising alarmingly. It is really upsetting having to accept that the population is less well served now than when I was trained. And I thought I was saving legs all the time!
Together with the busy programme directors BIBA Medical designed a programme to throw light on this matter. It soon emerged that the initiative would be pan-European to see if the problem is widespread and to see if the cures for the problem in each country are similar. The internationally renowned faculty was carefully briefed and followed a systematic approach. In particular the audience appreciated that the speakers went logically through all the vascular and non-vascular causes of leg/foot tissue loss, as illustrated by the ilegx wheel.
Michael Edmonds addressed almost 300 delegates from 24 different countries and from many disciplines including vascular, diabetes, endocrinology, dermatology, neurology, podiatry. Orthopaedic and plastic surgeons, wound care experts as well as vascular scientists and nurses attended.
He opened the ilegx consensus summit meeting with these words: "In the UK 100 legs per week are lost in diabetic patients" quoting Dr Douglas Smallwood, Chief Executive of diabetes UK. "Conservative estimates are that 50% of these are preventable. This is not acceptable".
It soon emerged that the rise in major amputations is by an increase in diabetic patients. On top of this, the prevalence of diabetes is increasing along with rising obesity in many western countries. Diabetic patients have an increased chance of arterial insufficiency and once an ulcer occurs, it can extend to amputation very fast indeed. The sugar laden tissues are a good culture medium for infection and it is vital to make the diagnosis rapidly. The faculty explained that diagnosis is achieved in the age-old way of history, physical examination and special investigations. There is a majority chance that an ulcerated foot has a vascular cause, arterial, venous or lymphatic. Vasculitis was discussed and the need to involve a dermatologist for this diagnosis emerged and with it the need for biopsy.
Michael Edmonds, Gunnar Tepe, Dieter Mayer with Richard Creel receiving the ilegx poster award
The second day began with prevention and I had a serious shock as a member of the audience. It simply appears too much to expect that a diabetic patient should be diagnosed earlier and the course of the disease altered. I had thought this would be the way. No. It seems the best we can hope for is for early referral once an ulcer has occurred. This was big news for me and raised the issue of why these patients are not referred sooner, if this is focally important!
Apparently about two ulcerated feet per year are likely to be seen by a general practitioner and he does not pay enough attention to something which occupies so little of his time. What is needed is urgent referral. There is little awareness which is not confined to one country. There is even talk of rewarding the doctor who does not refer to secondary care!
That is not all. There is an inbuilt obstruction to cross referral and interdisciplinary working is not encouraged. It is surmised that the rising amputation rate is because of a lack of referral to an open access interdisciplinary approach. Dr Edmonds champions this approach but I question if it is as easy now to set this up as it was when he started. Unfortunately the NHS has changed!
The summit led to an ilegx algorithm which reviews both diagnosis and definitive management of leg/foot tissue loss in the interdisciplinary team. The ilegx algorithm, in the shape of a turning wheel, highlights the diagnostic approach and reminds the specialist of key management steps and which disciplines he should include given a particular diagnosis. It is a powerful tool which simplifies this highly complex disease area. I hope it will help a lot of teams on a day to day basis.
This meeting was just a start. ilegx the interdisciplinary leg initiative will now strive to implement the developed best practice approach. ilegx will continue to educate the interdisciplinary team to overcome territorial barriers in the clinic as well as promoting open access interdisciplinary wound care centres. The ilegx academy will raise awareness in primary care and includes community education to drive early referral. And last but not least ilegx will campaign for removing systemic barriers in the national healthcare systems.
Roger Greenhalgh, Editor Vascular News Europe
The Presentations
The Programme
Our Sponsors
Poster presentation winner
Floorplan of the event PDF
