Developing a software program to manage data in a general practice setting is complicated. Vision Integrated Medical System is an example of a integrated management system that was developed by general practitioners, within a general practice, to offer a user friendly system with multi tasking capabilities. The present report highlights the reasons behind the development of this system and how it can assist day to day practice.
Diabetic foot lesions may arise from frictional trauma due to tight or inappropriate footwear, repetitive stresses on parts of the foot, overlying bony prominence generated by walking and accidental trauma to the neuropathic foot. Many diabetics have been found to be unaware of their foot lesion, or know what the precipitating cause was. Based on the assumption that accidental trauma would affect the foot in a random fashion and result in lesions distributed evenly throughout the foot, a study was performed to determine whether foot lesions were distributed evenly or concentrated to certain areas of predilection. It was found that foot lesions were not evenly distributed but concentrated to certain areas of predilection. Even though relatively high proportion of the study population walked about in open slippers and barefeet, the study showed that accidental trauma was not a predominant precipitant of diabetic foot lesions. Diabetic foot lesions tend to occur as a result of cumulative, repetitive trauma to areas of prediliection rather than accidental trauma.
Sixty inpatients with diabetic foot were studied prospectively at the Orthopaedic wards of Hospital Kuala Lumpur. Data was evaluated to document the patient profile and the factors that were associated with a major amputation (either above knee or below knee) of the lower limb. Factors that were associated with increased risk of amputation were a low education level, manual occupation, poor foot care, peripheral vascular insufficiency of the lower limb, insulin dependence, anaemia and leucocytosis. However only anaemia, leucocytosis and hyperglycaemia were statistically significant in predicting a more adverse surgical procedure. This study recommends that foot care awareness and practice is important. This can be effectively dealt with at specially organised, multi disciplinary Diabetic Foot Clinics.