Nurses' role in diabetic foot prevention and care; a review

Early intervention and care for Diabetic Foot Ulcers in Low and Middle Income Countries: Addressing challenges and exploring future strategies: A narrative review

Background and Aims

Diabetic Foot Ulcers (DFUs) are a significant health concern, particularly in Low- and Middle-Income Countries (LMICs). This review explores key strategies for managing DFUs in LMICs, including integrating podiatry, endocrinology, and wound care services, educating patients, promoting self-care, and preventive measures to reduce amputation rates.

Methods

A comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries.

Results

The aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence-based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing.

Conclusion

The burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self-care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow-up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient-centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life.

Effect of Chinese herbal compound dressings in treating patients with diabetic foot ulcers: A meta-analysis

This meta-analysis aims to systematically investigate the clinical efficacy of Chinese herbal compound dressings in treating patients with diabetic foot ulcers (DFUs). A comprehensive computerised search was conducted in databases including PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases, from database inception to November 2023, to identify randomised controlled trials (RCTs) concerning the use of Chinese herbal compound dressings in patients with DFU. Two researchers independently screened the literature, extracted data, and assessed the quality based on inclusion and exclusion criteria. Data analysis was performed using Stata 17.0 software. Overall, 18 RCTs involving 1405 DFU patients were included. The analysis indicated that compared to the control group, the group treated with Chinese herbal compound dressings had significantly shorter ulcer healing time (standardised mean difference [SMD] = -2.49, 95% confidence interval [CI]: -3.53 to -1.46, p < 0.001), reduced ulcer surface area (SMD = -3.38, 95% CI: -4.67 to -2.09, p < 0.001), and higher healing rates (odds ratio [OR] = 2.24, 95% CI: 1.72-2.92, p < 0.001) as well as overall effectiveness rates (OR = 4.56, 95% CI: 3.10-6.71, p < 0.001). This study demonstrates that the external application of Chinese herbal compound dressings in patients with DFU can significantly shorten the ulcer healing time and improve wound healing rates.

The impact of community teaching sessions on onward referral to specialist diabetic foot services

INTRODUCTION

Prompt referral of patients with diabetic foot ulceration (DFU) to specialist services can lead to more timely assessment of these patients and subsequent improved rates of limb salvage and patient outcomes. In this study we wanted to determine the impact of education in the primary care setting on onward referrals to our specialist Diabetic Foot multi-disciplinary team (MDT) clinic.

METHODS

As part of a Diabetic Foot Roadshow, four teaching sessions were delivered in primary care settings across Shropshire by our specialist team from 17th March to the 25th May 2022. Attendees included podiatrists, tissue viability nurses, district nurses and wound care practitioners. Hospital records were used to identify all onward referrals to our Diabetic Foot MDT clinic in the weeks before and after delivery of the roadshow education sessions.

RESULTS

184 referrals were made to the diabetic foot clinic from January to July 2022. There were 0.3 referrals per day in the months prior to the commencement of the education sessions, compared to 1.5 referrals per day following the commencement of the teaching sessions. This increase in referrals was statistically significant (p < 0.0001).

CONCLUSION

Teaching sessions delivered to community specialist healthcare professionals significantly increase onward referral of patients to specialist services, facilitating more timely assessment and management of patients with DFUs.

Diabetic Foot Ulcer Management and Treatment: An Overview of Published Patents

BACKGROUND

One of the most challenging effects of diabetes is diabetic foot ulceration (DFU). DFU may occur in up to one-third of individuals with diabetes mellitus (D.M.) at some point in their lives. The major cause of morbidity in D.M. patients is DFU. The length of treatment is difficult, and DFU recurrence is common.

OBJECTIVE

The most crucial element for the treatment and prevention of DFUs require a multidisciplinary approach. Patients who are at risk should be identified, depending on the type of risk, prophylactic actions etc. It is imperative to identify at-risk patients and take preventative measures accordingly.

METHOD

The at-risk diabetes-related foot ulcer was identified based on the risk category classification, while the foot ulcers were evaluated using Wagner's classification system.

RESULTS

Literature reported that patients with lower limb vascular insufficiency, loss of vibratory sensation, or protective sensation loss have an increased risk of developing foot ulcers. Proper categorization and therapeutic measures will be implemented after the DFU has been formed. The appropriate assessment and management of general health status should include glycemic control, the diagnosis and treatment of vascular disease, standard care for wounds, diagnosis, and infection treatments.

CONCLUSION

The review reflects the updated awareness of the treatment and management of DFU based on the current and past literature and patent analysis.

Efficacy of a Nursing Skin Care Protocol in the Prevention of Skin-Related Problems Among Newly Diagnosed Diabetic Patients: A Pilot Study

Introduction Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels, affecting millions worldwide. Among the various complications associated with diabetes, skin-related problems represent a significant concern, particularly for newly diagnosed patients. Altered blood circulation, compromised immune responses and nerve damage increase the risk of skin issues in this vulnerable population. Effective nursing interventions are crucial in managing and preventing diabetes-related skin problems. A nursing skin care protocol tailored to the unique needs of newly diagnosed diabetic patients has the potential to reduce the incidence and severity of skin complications, leading to improved patient outcomes and enhanced quality of life. This study aims to assess the efficacy of a nursing skin care protocol in preventing skin-related problems among newly diagnosed diabetic patients. By analyzing the impact of the protocol on patient outcomes and exploring the significance of early intervention and patient education, this research seeks to provide valuable insights into the importance of proactive skin care management in diabetes care. Methods A randomized controlled trial was conducted at Acharya Vinoba Bhave Rural Hospital in India to evaluate the efficacy of a nursing skin care protocol in preventing skin problems among newly diagnosed diabetic patients. The study included 30 patients who met specific inclusion criteria and excluded those with critical illness or undergoing skin treatment. Data was collected using a questionnaire and standardized tools. Statistical analysis demonstrated the protocol's effectiveness in reducing skin-related issues. The results highlight the importance of early intervention and personalized nursing care in diabetic management, promoting better patient outcomes and overall well-being. Results The results of the study demonstrate the efficacy of the nursing skin care protocol in reducing pruritus and dry skin problems among newly diagnosed diabetic patients. The experimental group showed a substantial improvement, with higher efficacy gains for both pruritus (66.70%) and dry skin (86.70%) compared to the control group (pruritus: 26.70%, dry skin: 33.30%). These findings highlight the potential benefits of implementing the nursing skin care protocol to alleviate skin-related issues in this patient population. The study supports the importance of early intervention and tailored nursing care in managing diabetic skin problems, which could improve patient outcomes and overall well-being. Conclusion In conclusion, the nursing skin care protocol effectively prevented and reduced skin-related problems among newly diagnosed diabetic patients. The experimental group showed significant improvements in pruritus and dry skin compared to the control group. Early intervention and personalized nursing care are crucial in managing diabetic skin issues and enhancing patient well-being. Implementing the nursing skin care protocol can lead to a better quality of life for diabetic patients by addressing skin concerns. Further research and application of this protocol hold promise for managing skin-related complications in diabetes effectively.

A qualitative exploration of adherence to wearing removable cast walkers in patients with diabetic foot ulcers

OBJECTIVE

To explore adherence to wearing removable cast walkers (RCWs) among patients with diabetic foot ulcers (DFUs).

METHOD

A qualitative study was conducted by interviewing patients with active DFUs and using knee-high RCWs as their offloading treatment. The interviews were undertaken at two diabetic foot clinics in Jordan, using a semi-structured guide. Data were analysed through content analysis by developing main themes and categories.

RESULTS

Following interviews with 10 patients, two main key themes with a total of six categories were identified: theme 1-reporting of adherence levels was inconsistent, included two categories: i) a belief in achieving optimal adherence, and ii) non-adherence was often reported indoors; and theme 2-adherence was a consequence of multiple psychosocial, physiological and environmental factors, which included four categories: i) specific offloading knowledge or beliefs influenced adherence; ii) severity of foot disease influenced adherence; iii) social support benefitted adherence; and iv) physical features of RCWs (the usability of the offloading device) impacted adherence.

CONCLUSION

Patients with active DFUs reported inconsistent levels of adherence to wearing RCWs which, after deeper investigation, seemed to be due to participants' misperceptions of the optimal adherence. Adherence to wearing RCWs also seemed to be impacted by multiple psychosocial, physiological and environmental factors.

Hypertonic saline solution 5% as an effective cost-beneficial alternative to normal saline for wound healing in patients with diabetic lower-extremity ulcers: a randomized controlled trial

Background

Diabetic foot ulcer is among the most common complications and causes of mortality and morbidity in patients with diabetes. Herein, we propose using 5% Hypertonic Solution as an alternative to Normal Saline in treating patients with diabetic foot ulcers as an effective cost-benefit therapeutic approach.

Methods

In this clinical trial, 100 patients with diabetic foot ulcers were divided into two groups. Foot ulcer was washed and treated three times a day with the 5% hypertonic saline solution in the first group, while the second group was treated with normal saline 0.9% and normal washing. Patients were examined for the size and depth of the wound weekly, and the results were recorded after six weeks.

Results

The mean length and width of the wound in the experimental group significantly decreased six weeks after the start of treatment with hypertonic saline (p < 0.05). The wound healing rate was lower after treatment in both groups of patients who had a longer disease duration and higher HbA1c.

Conclusion

Treating diabetic foot ulcers with hypertonic saline solution may help improve wound healing. Therefore, rinsing with hypertonic saline is a cheap, safe, simple, and non-invasive treatment protocol for these patients.

Prediction of Foot Ulcers Using Artificial Intelligence for Diabetic Patients at Cairo University Hospital, Egypt

Introduction

In Egypt, diabetic foot ulcers markedly contribute to the morbidity and mortality of diabetic patients. Accurately predicting the risk of diabetic foot ulcers could dramatically reduce the enormous burden of amputation.

Objective

The aim of this study is to design an artificial intelligence-based artificial neural network and decision tree algorithms for the prediction of diabetic foot ulcers.

Methods

A case-control study design was utilized to fulfill the aim of this study. The study was conducted at the National Institute of Diabetes and Endocrine Glands, Cairo University Hospital, Egypt. A purposive sample of 200 patients was included. The tool developed and used by the researchers was a structured interview questionnaire including three parts: Part I: demographic characteristics; Part II: medical data; and Part III: in vivo measurements. Artificial intelligence methods were used to achieve the aim of this study.

Results

The researchers used 19 significant attributes based on medical history and foot images that affect diabetic foot ulcers and then proposed two classifiers to predict the foot ulcer: a feedforward neural network and a decision tree. Finally, the researchers compared the results between the two classifiers, and the experimental results showed that the proposed artificial neural network outperformed a decision tree, achieving an accuracy of 97% in the automated prediction of diabetic foot ulcers.

Conclusion

Artificial intelligence methods can be used to predict diabetic foot ulcers with high accuracy. The proposed technique utilizes two methods to predict the foot ulcer; after evaluating the two methods, the artificial neural network showed a higher improvement in performance than the decision tree algorithm. It is recommended that diabetic outpatient clinics develop health education and follow-up programs to prevent complications from diabetes.

The effect of topical olive oil dressing on the healing of grade 1 and 2 diabetic foot ulcers: An assessor-blind randomized controlled trial in type 2 diabetes patients

BACKGROUND AND AIMS

We aimed to compare the effect of topical olive oil dressing plus standard care with standard care alone on the treatment of grade 1 and 2 diabetic foot ulcers (DFUs) in type 2 diabetes mellitus (T2DM) patients.

METHODS

This assessor-blind randomized controlled trial included 60 T2DM patients with DFU referred to the Diabetes Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from February 21 to August 22, 2017. Patients were randomly assigned to intervention (n = 30) and control (n = 30) groups. The intervention group received standard care, including wound irrigation with normal saline and oral antibiotics plus daily topical olive oil dressing for four weeks, and the control group only received standard care. The wound healing assessment scale (wound degree, color, drainage, and surrounding tissue healing) was recorded weekly and the total wound status was determined at the end of the study.

RESULTS

Treatment with olive oil led to significantly higher scores of ulcer degree, color, drainage, and surrounding tissue healing at weeks one, two, three and four in the olive oil group than in the control group (P < 0.001). Also, the total wound status score was higher in the olive oil group compared to the control group (P < 0.001). The proportions of completely healed, partially healed, and unhealed wounds were 76.6%, 23.3% and 0% in the intervention group, and 0%, 93.3% and 6.7% in the control group, respectively.

CONCLUSIONS

Topical olive oil dressing promoted the healing of DFU and it can be recommended as a safe and effective treatment in this regard.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT), IRCT20150607022585N4. Registered 05/12/2018. Retrospectively registered, https://www.irct.ir/trial/19460.

Non-Specialized Nurses Roles in Diabetes Inpatient Care in Cyprus: An Interpretive Phenomenological Analysis

Aim: The aim of the study was to understand how non-specialized nurses and people with diabetes understand nurses’ roles in diabetes inpatient care. Background: Diabetes mellitus is a major public health issue that places a significant burden on patients and healthcare systems and world leaders have targeted it for priority action. Design: An interpretative phenomenology approach (IPA). Methods: A total of 24 non-specialized nurses working in medical, surgical and nephrology wards and 24 people with type 1 diabetes who use the services of the state hospitals in Cyprus. The data were collected in two phases: firstly, focus groups with nurses (n = 1) and people with diabetes (n = 2) were conducted and analysed and then individual semi-structured interviews with nurses (n = 18) and with people with diabetes (n = 12) were conducted. Findings: It is evident from the study findings that nurses experience several roles in diabetes inpatient care. Most of these roles have been identified by people with diabetes as well. These roles are summarized as follows: medication administration, patient education, screening of complications, diet and psychological support. However, most of the participants raised concerns about nurses’ ability to conduct such roles. Conclusion: Participants suggest that nurses experience several roles in caring for diabetes inpatients and this view was also shared by people with diabetes. However, it was obvious that these roles differ between specialities. The findings showed that even though participants recognized a number of roles in diabetes inpatient care, their description of how they perform these roles was vague, and they raised concerns about their readiness to take on some of these roles.

Nursing student's knowledge and attitude toward diabetic ulcer care and their contributing factors in Indonesia

Objective

The prevalence of diabetic foot ulcer in Indonesia is far greater than the global prevalence. Nursing students are expected to have good knowledge and positive attitudes regarding diabetic ulcer care in order to deliver high-quality wound care during clinical practice. This study aimed to assess nursing students’ knowledge and attitudes toward diabetic ulcer care and to investigate the factors related to them.

Methods

A cross-sectional study was conducted on 396 academic and clinical phases in three nursing schools in Indonesia from September 2021 to February 2022. Participants completed a survey including a questionnaire about knowledge and attitudes regarding diabetic ulcer care. The data were analyzed using a Chi-square test and multivariate logistic regression analysis.

Results

The results show that 43.2% (171/396) of nursing students had inadequate knowledge of diabetic ulcer care. However, 88.9% (352/396) had a favorable attitude toward the topic. Nursing students lacked knowledge about the characteristics of diabetic ulcers, diabetic neuropathy, wound infection, and adjunctive therapy for diabetic ulcers, and many of them believe that diabetic ulcer care is too time-consuming to carry out. Students in the clinical phase of their studies had significantly better knowledge than those in the academic phase (aOR = 9.99, 95% CI 4.96–20.08, P < 0.001). Male nursing students were significantly less likely to have positive attitude toward the topic than female students (aOR = 0.42, 95% CI 0.19–0.96, P = 0.048), and students accustomed to sharing with peers as a source of knowledge had better attitudes than those who were not (aOR = 2.76, 95% CI 1.40–5.41, P = 0.003).

Conclusion

Findings show that almost half of the nursing students have insufficient knowledge of diabetic ulcer care. Curriculum developers and educators need to improve the curriculum regarding diabetic wound care and provide strategic programs to improve students’ knowledge and attitudes based on the factors discovered in this study.

Diabetic foot workshop: A strategy for improving the knowledge of diabetic foot care providers

BACKGROUND AND AIMS

Prevention and management of diabetic foot ulcer have essential effects on the quality of life of patients. Accordingly training the care providers can play an essential role in reducing complications foot ulcers and lead to an increase in the effectiveness and efficiency of patient health cares. We conducted a study to survey the impact of the diabetic foot workshop on the knowledge of nurses and physicians about diagnosis and managing diabetic foot.

METHODS

The present study is a quasi-experimental which compare the knowledge of non-randomized group of nurses and physicians about diabetic foot care. The leaning objectives, agenda, contents and evaluation methods of the diabetic foot care workshop was designed by a multidisciplinary team members in form of 2 days workshop. Each topic of the workshop presented theoretically and practically using educational cases and real patient with diabetic foot ulcer. A valid and reliable questionnaire with 20 Multiple Choice Questions used for the evaluation of workshopin form of the pretest and posttest.

RESULTS

In this study, 396 registered nurses and physicians participates in the diabetic foot workshop series. The results of this study showed that this increase in the level of knowledge was meaningful after the educational intervention since the mean of the posttest score increased more than 20% comparing with pretest.

CONCLUSION

The promotion of knowledge of health care providers as shown in the study may almost be due to training by real patient, team-working, and using educational movies for the education of diabetic foot diagnosis, management and rehabilitation.

Health Education Programmes to Improve Foot Self-Care Knowledge and Behaviour among Older People with End-Stage Kidney Disease (ESKD) Receiving Haemodialysis (A Systematic Review)

Background: ESKD is a total or near-permanent failure in renal function. It is irreversible, progressive and ultimately fatal without peritoneal dialysis (PD), haemodialysis (HD) or kidney transplantation. Dialysis treatments can create new and additional problems for patients, one of which is foot amputation, as a result of non-healing wounds and vascular complications. The association between dialysis therapy and foot ulceration is linked to several factors: physical and psychological health; peripheral arterial disease (PAD); mobility; tissue oxygenation; manual dexterity; neuropathy; visual acuity; anaemia; nutrition; leg oedema; hypoalbuminemia; infection; inadequacy of dialysis; and leg/foot support during dialysis. The potential risk factors for foot ulceration may include: not routinely receiving foot care education; incorrect use of footwear; diabetes duration; neuropathy; and peripheral arterial disease. Aim: The aim of this review is to examine the factors that help or hinder successful implementation of foot care education programmes for ESKD patients receiving haemodialysis. Method: A comprehensive literature search was completed using five electronic databases. Medline; CINAHL; Embase; PsycINFO; and Cochrane Library. The Joanna Briggs Institute checklist (JBI) was used to quality appraise full text papers included in the review. The systematic review was not limited to specific categories of interventions to enable optimal comparison between interventions and provide a comprehensive overview of the evidence in this important field of foot care. Results: We found no previously published studies that considered foot care education programmes for haemodialysis patients who are not diabetic; thus, the present systematic review examined four studies on diabetic patients receiving haemodialysis exposed to foot care education programmes from various types of intervention designs. Conclusions: This systematic review has provided evidence that it is possible to influence foot care knowledge and self-care behaviours in both diabetic patients receiving haemodialysis and healthcare professionals.

Development and Usability Evaluation of a Telemedicine System for Management and Monitoring of Patients with Diabetic Foot

Objectives: The aim of the present study was to develop and evaluate the usability of a telemedicine system for management and monitoring of patients with diabetic foot.Methods: This study was conducted in four phases. In the first phase, the information needs and characteristics required to design the telemedicine system were identified based on a literature review. Then, in a two-stage Delphi survey, 15 experts approved the identified information needs and characteristics. The prototype telemedicine system was then designed. In the third phase, system usability was evaluated through a semi-structured interview. In the fourth phase, users’ satisfaction with the designed system was analyzed.Results: Out of 115 information needs and required characteristics, 95 were considered in the system design. Eight main pages for enabling patient-physician interactions and physician-physician interactions, monitoring the patient and controlling the disease process, providing medical consultation, and prescribing medications were considered. In the third phase, 26 distinct problems were identified. However, 75% of the participants were very satisfied with the system.Conclusions: This study presents an attempt to design and evaluate a telemedicine system for the management and monitoring of patients with diabetic foot. In this system, patients receiving medical services or physicians who encounter rare cases can send the complete medical history, clinical test results, and videos and images related to the foot to specialist physicians. After examining the medical history or images and videos, the physician can provide the necessary medication prescriptions and laboratory tests or other recommendations.

The barriers and facilitators of foot care practices in diabetic patients in Indonesia: A qualitative study

AIM

To investigate the barriers and facilitators of foot care practice in diabetic patients in Indonesia.

DESIGN

A qualitative content analysis with an inductive approach.

METHOD

Semi-structured interviews were conducted on 34 type 2 diabetes mellitus (T2DM) patients, health providers and family members in Purwokerto, Indonesia, between July 2020 and December 2020. The interview transcripts were coded using NVivo 12.

RESULTS

Four themes emerged from data analysis, including personal barriers (low susceptibility of developing foot ulcer, limited knowledge about foot care, fatalistic practices, financial problems, glucose control taking priority over foot care, lack of motivation, lack of confidence, fear of being labelled), environmental barriers (lack of knowledge and time of health providers, lack of family support and climate conditions), perceived foot health benefits (intention to feel better and desire to stay socially active) and religious practices (foot washing as part of religious practice and intention to feel clean before praying).

Knowledge, Practice and Attitude towards Foot Ulcers and Foot Care among Adults Living with Diabetes in Tobago: A Qualitative Study

Globally, the prevalence of diabetes has risen significantly by 62% over the last ten years. A complication of unmanaged diabetes is diabetic foot ulcer (DFU), which adversely affects the quality of life of individuals with diabetes and inflicts a huge economic burden on the family, government, and health care services. However, this complication is preventable with adequate patient knowledge and practice regarding DFU and foot care. The present study was aimed at assessing the knowledge, attitude, and practice of adults with diabetes on foot ulcers and foot care in Tobago using a qualitative exploratory design. Purposeful sampling technique was used to recruit 20 participants from the lifestyle and diabetes foot clinics of Scarborough Health Centre, Tobago. Telephone interviews were conducted with the use of a semi-structured interview guide. The data obtained from participants were analyzed using thematic content analysis. Four major themes, namely foot ulcer problems, participants’ knowledge on DFU, knowledge on foot care, and practice and attitude of foot care, emerged from the study. The findings from the study revealed that the majority of participants had poor knowledge regarding DFU but exhibited awareness about foot care, especially on foot cleaning and inspection, preventing irritation after washing, appropriate footwear, and not walking barefooted. The participants had good attitudes and practices of foot care despite their poor knowledge of DFU. However, participants reported inadequate health education on DFU and foot care from healthcare personnel. There should be improved health education, information, and communication on DFU and foot care centred and tailored to the understanding of people living with diabetes. This will prevent DFU and reduce the mortality arising from this complication, which is a major target of the sustainable development goals (SDG) in mitigating the burden of non-communicable diseases (NCD) such as diabetes.

Knowledge and practice of diabetic foot care and the prevalence of diabetic foot ulcers among diabetic patients of selected hospitals in the Volta Region, Ghana

Diabetic foot ulcers (DFUs) are a common but serious complication of diabetes mellitus (DM). The factors distressing the worth of diabetic foot care (DFC) are knowledge and practice. Foot ulcers are the main cause of amputation and death in people suffering from DM. This study assessed the knowledge and practice of DFC and the prevalence of DFUs and its associated factors among diabetic patients of selected hospitals in the Volta Region, Ghana. A multihospital‐based cross‐sectional study was conducted among 473 patients with DM who were recruited using the systematic sampling method. Data were collected using a validated, pretested, and structured questionnaire, while medical variables were obtained from patient folders and analysed using SPSS version 23. All statistically significant parameters in bivariate analysis were incorporated in the multivariate logistic regression analysis. The results showed that 63% of diabetic patients had good knowledge of DFC, while 49% competently practiced it. A negative correlation was found between knowledge and practice levels of DFC (r = −0.15, P = <.01). The prevalence of DFUs was 8.7% among the studied diabetic patients. Male diabetic patients were 3.4 times more likely to develop DFUs than female diabetic patients (crude odd ratio [cOR] = 3.35; 95% confidence interval [CI] = 1.75‐6.43; P = <.001). Type 1 diabetic patients were five times more likely to develop DFUs than those who had type 2 diabetes (cOR = 5.00; 95% CI = 2.50‐10.00; P = <.001). Diabetic patients who had a family history of diabetes were 4.7 times more likely to develop DFUs than those without family history (adjusted odd ratio [aOR] = 4.66; 95% CI = 1.55‐13.89; P = .006). Those who had diabetes for 5 to 10 years were 3.3 times more likely to develop DFUs than those who had diabetes for less than 5 years (aOR = 3.28; 95% CI = 1.40‐7.67; P = .006). Diabetic patients who had comorbidity were 3.4 times more likely to develop DFUs than those without comorbidity (cOR = 3.35; 95% CI = 1.74‐6.45; P = <.001). The study found that there was good knowledge but poor practices of DFC among patients. Health care providers are expected to better educate patients and emphasise self‐care practices to patients. Health care providers should also give more attention to patients with associated risk factors to avoid further complications and reduce the occurrence of DFUs.

A smart wearable device for monitoring and self-management of diabetic foot: A proof of concept study

BACKGROUND AND OBJECTIVE

Diabetic foot is one of the important complications of diabetes, which is occurred due to the destructive parameters in different anatomical sites of feet. Management and monitoring of these parameters are very important to decrease or prevent foot ulcers. We aimed to develop a smart wearable device to monitor these parameters to prevent diabetic foot.

METHODS

Following literature review and expert panel discussions, we considered pressure, temperature and humidity to develop the system. During these sessions, we also developed the system architecture and determined the required technologies. We also developed a mobile application. Finally, all sensors were evaluated for accurate monitoring of pressure, temperature and humidity. A standard protocol was used to evaluate each of these sensors. To this end, five people (four with diabetes and one healthy person) participated. They did a series of movements including walking, sitting, and standing. We considered the pressure measured by Pedar system as the gold standard. Furthermore, we changed the environment temperature and humidity during several experiments and considered the environment temperature and humidity as gold standard. We compared the measured values by sensors with these gold standards.

RESULTS

The evaluation indicated the accurate performance of pressure, humidity and temperature sensors. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the system to provide alarms based on the pressure measured using Pedar were 100, 50, 92.5, 91.8, and 100 %, respectively. The performance of temperature sensors in smart shoes was confirmed by slight differences compared to thermometers. Relatively equal values of humidity measured by two sensors on the left and right feet and the increased difference with the environment humidity showed the exact humidity measured using these sensors.

CONCLUSION

This smart shoes monitors pressure, humidity, and temperature of patients' feet and sends this data to their smart phone by the Bluetooth module. Furthermore, it controls these parameters; as each of these parameters exceeds the defined threshold, alerts are given to patients for self-management.

Nurses' knowledge and attitude towards diabetes foot care in Bahir Dar, North West Ethiopia

A diabetes foot ulcer is the commonest non-traumatic reason for the amputation of the lower extremities. All adults with diabetes should undergo comprehensive foot evaluation at least annually, but for high-risk individuals with diabetes more frequently by a health care provider and daily by the people themselves. Nurses' knowledge and attitude are fundamental to conduct a diabetes foot risk assessment and provide foot care for known diabetes person. Knowledge and attitude of nurses about the assessment and risk, identification of diabetes foot are not well studied in Ethiopia, especially in the study area. Therefore, this study aimed to assess nurses' knowledge and attitude towards diabetes foot ulcer in Bahir Dar, North West Ethiopia. An institution-based cross-sectional study was conducted in Bahir Dar city administration hospitals from January 1st to 5th, 2019. The study participants were selected using a simple random sampling technique. Nurses' level of knowledge and attitude towards diabetes foot ulcer assessment and management determined by using multiple-choice questions of nurse's knowledge and attitude questionnaires. The association between the independent and dependent variables was assessed. In this study, the overall proportions of nurses' knowledge and attitude towards diabetes foot assessment and management were 54.4% and 43.3% respectively. Age less than 30 years old (AOR = 2.15, 95%CI: 1.10, 4.19; P = 0.025), the nurse who graduates from a governmental institution (AOR = 3.05, 95% CI: 1.64, 5.69; P < 0.001) and use the internet as a source of knowledge (AOR = 0.55, 95%CI: 0.31, 0.96; P = 0.035) was significantly associated with nurses' knowledge towards diabetes foot care. Age less than 30 years old (AOR = 1.98, 95% CI: 1.16, 3.35; P = 0.012)and the nurse level of qualification (AOR = 0.39, 95% CI: 0.20, 0.78; P = 0.007)were significantly associated with nurses' level of attitude towards diabetes foot care. In conclusion, this study demonstrated the important gaps in nurses' knowledge and attitude towards diabetes foot care. Nurses' insufficient knowledge and non-favorable attitude towards diabetes foot care compromise health care standard diabetes care. Therefore, a comprehensive revision of nursing curricula across local tertiary learning institutes required qualified instructors and a strengthened regulatory body (especially private ones), and validated source of information for allowing nurses to update their knowledge is warranted.

Prioritisation of diabetes-related footcare amongst primary care healthcare professionals

AIMS AND OBJECTIVES

To assess primary healthcare professionals' priority for managing diabetic foot disease (DFD) over the progressive course of the condition compared to other aspects of diabetes care.

BACKGROUND

DFD affects up to 60 million people globally. Evidence suggests that comprehensive preventative footcare may reduce serious complications of DFD, such as amputation.

DESIGN

A cross-sectional quantitative study reported according to STROBE statement.

METHODS

General Practitioners (GPs) and Credentialled Diabetes Educators (CDEs) working within Australian primary care were invited to complete an online survey, to obtain information about preventative and early intervention footcare priorities and practices. Ten GPs and 84 CDEs completed the survey.

RESULTS

On diagnosis of type 2 diabetes, haemoglobin A1c (HbA1c) review was identified to be one of the top three priorities of care by 57 (61%) of participants whilst at 20-year history of diabetes 73 (78%) participants indicated its priority. Foot assessments became a priority for 78% (n = 73) of participants and podiatry referrals a priority for 53% (n = 50) of participants only when a "foot concern" was raised. Referrals to specialist high-risk foot podiatrists or services were a first priority for 56% (n = 53), when the person had significant amputation risk factors.

CONCLUSION

Diabetes-related preventative footcare assessments and management remain a low priority amongst primary healthcare professionals. Preventative care for asymptomatic complications, such as DFD, may be overlooked in favour of monitoring HbA1c or medication management. Limited prioritisation of footcare in primary care is concerning given the risks for amputation associated with DFD.

RELEVANCE TO CLINICAL PRACTICE

This study reveals the need for primary healthcare decision makers and clinicians to ensure preventative footcare is a focused priority earlier in the diabetes care continuum. Collaborative and widespread promotion of the importance of proactive rather than reactive footcare practices is required to support prevention of foot ulcers and amputation.

Inter-rater reliability of four validated diabetic foot ulcer classification systems

BACKGROUND

The need to classify, score and describe diabetic foot ulcerations is needed for accurate clinical documentation. An agreed wound classification can improve communication between health care professionals, and improve ease of discussion regarding potential outcomes. This study aimed to determine the inter-rater reliability between four validated wound classification systems.

RESEARCH DESIGN AND METHOD

A prospective non-experimental comparative study was conducted. Forty patients with diabetes presenting with a new or long-standing ulceration were recruited. Each ulcer was graded/scored by three clinicians using four widely used classification systems; namely the University of Texas, SINBAD, Meggitt-Wagner and the PEDIS scoring systems.

RESULTS

All classifications had a satisfactory inter-rater agreement when evaluated by three raters of various clinical experience, however, the strength of the agreement varied between classifications. The Meggitt-Wagner system had an almost perfect agreement, the SINBAD and UT systems had a strong inter-rater agreement whilst the PEDIS had a moderate inter-rater agreement.

CONCLUSION

Results of study serve as assurance and provides the evidence that these systems may be reliably used by different clinicians, even those with varied experience in wound care.

Improving clinical outcomes of diabetic foot ulcers by the 3-month self- and family management support programs in Indonesia: A randomized controlled trial study

BACKGROUND AND AIMS

Diabetic foot ulcers are the leading cause of lower extremity amputations, which require more effective prevention. Even though previous nursing studies on diabetic foot ulcers have been well performed, programs implementing self- and family management are limited and even underexplored. Therefore, the purpose of the study was to investigate the effect of 3-month self- and family management support programs on clinical outcomes among Indonesians with diabetic foot ulcers.

METHOD

The randomized controlled trial design was used to answer the research question of the study. A total of 56 eligible participants were enrolled, with 27 in the experimental group and 29 in the control group. The experimental group received self- and family management support programs for three months. Meanwhile, the control group received usual care. Descriptive statistics, multivariate analysis of variance, and Generalized Estimating Equations were used to analyze the data. The significance level was considered at .05 for hypothesis testing.

RESULTS

The study showed that there were statistically significant improvements in self-management, family supports, hemoglobin A1c, and wound size after implemented the programs for three months (p < .05).

CONCLUSIONS

With regard to the result of the study, implementing the 3-month self- and family management support programs improves the patients' and families' abilities to perform diabetic foot ulcer care at home.

Implementation of spiritual care in patients with diabetic foot ulcers: a literature review

Lower extremity amputation is a complication of diabetic foot ulcers that can cause spiritual crisis. Integrating spiritual care into nursing practice is important to overcome this. However, studies articulating the role of nurses in spiritual care when caring for patients with diabetic foot ulcers is limited. This article aims to describe the importance of providing spiritual care for this group of patients. The interpretation of spiritual care with respect to the relationship between the patient and the family, and the role of the nurse are discussed. The findings offer a theoretical perspective on spiritual care that can be used to develop spiritual interventions, as well as prevent spiritual crises in patients with diabetic foot ulcers.

Towards a Better Understanding of Transfer Learning for Medical Imaging: A Case Study

One of the main challenges of employing deep learning models in the field of medicine is a lack of training data due to difficulty in collecting and labeling data, which needs to be performed by experts. To overcome this drawback, transfer learning (TL) has been utilized to solve several medical imaging tasks using pre-trained state-of-the-art models from the ImageNet dataset. However, there are primary divergences in data features, sizes, and task characteristics between the natural image classification and the targeted medical imaging tasks. Therefore, TL can slightly improve performance if the source domain is completely different from the target domain. In this paper, we explore the benefit of TL from the same and different domains of the target tasks. To do so, we designed a deep convolutional neural network (DCNN) model that integrates three ideas including traditional and parallel convolutional layers and residual connections along with global average pooling. We trained the proposed model against several scenarios. We utilized the same and different domain TL with the diabetic foot ulcer (DFU) classification task and with the animal classification task. We have empirically shown that the source of TL from the same domain can significantly improve the performance considering a reduced number of images in the same domain of the target dataset. The proposed model with the DFU dataset achieved F1-score value of 86.6% when trained from scratch, 89.4% with TL from a different domain of the targeted dataset, and 97.6% with TL from the same domain of the targeted dataset.

Impact of diabetes education teams in primary care on processes of care indicators

AIMS

To evaluate the impact of the integration of onsite diabetes education teams in primary care on processes of care indicators according to practice guidelines.

METHODS

Teams of nurse and dietitian educators delivered individualized self-management education counseling in 11 Ontario primary care sites. Of the 771 adult patients with HbA1c ≥7% who were recruited in a prospective cohort study, 487 patients attended appointments with the education teams, while the remaining 284 patients did not (usual care group). Baseline demographic, clinical information, and patient care processes (diabetes medical visit, HbA1c test, lipid profile, estimated glomerular filtration rate, and albumin-to-creatinine ratio, measuring blood pressure, performing foot exams, provision of flu vaccine, and referral for dilated retinal exam) were collected from patient charts one year before (pre period) and after (post period) the integration began. A multi-level random effects model was used to analyze the effect of group and period on whether the process indicators were met based on practice guidelines.

RESULTS

Compared to the usual care group, patients seen by the education teams had significant improvements on indicators for semi-annual medical visit and annual foot exam. No significant improvements were found for other process of care indicators.

CONCLUSIONS

Onsite education teams in primary care settings can potentially improve diabetes management as shown in two process of care indicators: medical visits and foot exams. The results support the benefits of having education teams in primary care settings to increase adherence to practice guidelines.

Behaviour model for diabetic ulcer prevention

Purpose

Diabetic ulcers are one of the complications that often occur in patients with DM. The aim is to develop a behaviour model for diabetic ulcer prevention by integrating Lawrance Green Theory and the Theory of Planned Behaviour.

Methods

An explanative observational design was used with a cross-sectional approach. The population consisted of DM patients who had underwent treatment at the internal medicine clinic of Sidoarjo District Hospital. The sample size of 133 respondents was obtained through purposive sampling. The data analysis used Partial Least Square.

Results

Predisposing factors (knowledge), supporting factors (availability of health facilities and accessibility of health resources) and driving factors (the role of health workers and family support) significantly influence the main factors (attitudes toward behaviour, subjective norms and perceptions of self-control) with a statistical T value>1.96. The main factor influences intention (T = 48.650) and intention influences behaviour (T = 4.891).

Conclusion

Intention is influenced by the attitudes toward behaviour, subjective norms and self-control perceptions. Good intentions can increase the preventive behaviour related to diabetic ulcers. Increasing the diabetic ulcer prevention behaviour can be done by providing regular education to both the patients and their families about diabetic ulcers and their prevention through the appropriate management of DM, lifestyle modification and regular foot care that requires active involvement from the family and health care workers.

Monitoring of external predisposing factors for Diabetic Foot: A literature review and physicians' perspectives

Background: Diabetic foot is one of the most important complications of diabetes caused by the existence of some destructive factors in different anatomical locations of feet. Management and monitoring of these factors are very important to decrease or avoid ulcerating lesions of the foot. The purpose of this study is to identify and introduce the predisposing factors and anatomical locations associated with these destructive factors. Methods: First, we conducted a comprehensive review of different databases to identify the factors and associated anatomical locations from the previous studies. Then, we designed a questionnaire and invited physicians and specialists to express their perspectives on these factors and locations. The data were analyzed using SPSS version 23. Frequency, percentage, mean and standard deviation of these variables were calculated. Results: Based on the literature review, four factors, including pressure, moisture and sweat, temperature, and acceleration were identified as factors destructive to the tissues of the diabetic foot and worsen ulcers. The view of specialists approved the results of the literature review. Besides, there was an insignificant difference between the results of the literature review and the specialists' view in terms of anatomical locations that need to be continuously monitored. Conclusion: Monitoring the pressure in heel, first metatarsal, and first metatarsal head; moisture and sweat under the fingers, hallux and heels as well as the temperature at the first metatarsal, first metatarsal head, and the third metatarsal head are important in preventing ulceration, destructing the foot tissue, and accelerating the treatment process.

Effect of Foot Exercise and Care on Peripheral Vascular Status in Patients with Diabetes Mellitus

Introduction: Diabetes mellitus is a cause of health problems which occurs in most countries. Approximately 13 - 15% of all patients with diabetes mellitus will experience peripheral circulatory disorders. Foot exercise and foot care are interventions that can be implemented to prevent foot ulcers.Methods: This study employed a pre-post-test quasi-experimental design with a control group. The sample consisted of 94 patients with diabetes mellitus who were assigned to the intervention group (n=47) and the control group (n=47) respectively. Consecutive sampling was used to recruit the samples. The instruments used to collect the data included 10-g monofilament for the diabetic neuropathy test, a HbA1c test and a sphygmomanometer. The collected data was analyzed using a paired t-test.Results: The results of this study showed there to be significant effects from foot exercise and foot care on the HbA1c test, in relation to the frequency of the dorsalis pedis artery and diabetic neuropathy with a significance value of 0.00 (p<0.05). However, in the ankle-brachial index measurement, there were no significant differences between the intervention and control groups with a significance value of 0.26 (p>0.05).Conclusion: Foot exercise and foot care can be one of the independent nursing interventions used to prevent the complications of diabetes mellitus, as they have been proven to improve the peripheral vascular status of patients with diabetes mellitus by 70-80%.

Effect of nurse-led care on quality of care and level of HbA1C in patients with diabetic foot ulcer: A randomized clinical trial

Diabetic foot ulcer (DFU) is a serious and costly complication in diabetes which affects different aspects of life and can reduce patient's quality of life. Various views to manage DFU have been introduced. The nurse-led team, as a multidisciplinary team, can be effective due to a holistic approach to some disease management; but in patients with DFU it has not been assessed. Therefore, this study was designed to determine the effect of nurse-led care on quality of care (QOC) and improvement of HbA1C in Patients with DFU. This was a randomized clinical trial study performed on 52 patients with DFU. Patients were randomly assigned into two groups: nurse-led care intervention and standard care. The study was conducted in one of the hospitals affiliated to Tehran University of Medical Sciences. Data were collected using two questionnaires: Demographic characteristics and Quality Patient Care Scale (QUALPACS) and taking a blood sample for HbA1C. The nurse-led Care interventions were conducted in three stages: Integrated, Interdisciplinary, and Comprehensive. Descriptive and analytic statistical methods were used to analyze the data. P < .05 was considered significant. The results demonstrated that according to repeated measures test, (before, 4 and 12 weeks after the intervention), the level of QOC dimensions (Psychosocial, communication and physical aspect) in the nurse-led group had a significant difference with control group (P < .0001). Also, according to the results of Independent t test, there was a significant difference in total QOC scoring and HbA1c between intervention and control groups after the intervention and follow up (P < .0001). Considering the burden of diabetes and DFUs, it seems that the establishment of a nurse-led care approach can be an effective strategy to manage and treat these patients, and eliminate the disruption of care and achieve optimal care quality.

A multidisciplinary team approach in Iranian diabetic foot research group

Diabetic Foot (DF) as a common complication of Diabetes needs to intensive intervention for prevention, management and rehabilitation. In this regard, the Iranian Diabetic Foot Research Group (IDFRG) of Diabetes Research Center of Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) with multi-disciplinary approach have begun its activity since 2014. The aim of this paper is introducing the IDFRG in four main categories including Education, Research, Knowledge Translation and Clinical Care. According to the strategic plan, Future activities would be considered as five following areas: National Diabetic Foot Research Network (NDFRN) Establishment, Podiatrist Curriculum Development, Iranian Diabetic Foot Registry System (IDFRS) Launch, DF guideline Implementation and last but not least DF Ward Establishment.

Autologous platelet-rich gel and continuous vacuum sealing drainage for the treatment of patients with diabetic foot ulcer: Study Protocol

BACKGROUND

Research focusing on the efficacy of autologous platelet-rich gel (APRG) and continuous vacuum sealing drainage (CVSD) for diabetic foot ulcer (DFU) is increasing. Despite increasing knowledge on this theme, its results remain inconsistent. Thus, we will provide insight into the efficacy of APRG and CVSD for patients with DFU.

METHODS

We will search electronic databases of MEDILINE, EMBASE, Cochrane Library, CINAHL, AMED, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to October 1, 2019. No language limitation is utilized to these databases. Two authors will independently perform study selection, data extraction, and risk of bias assessment. Disagreements between 2 authors will be solved through discussion with a third author.

RESULTS

The efficacy and safety of APRG and CVSD for patients with DFU will be assessed by the time to complete healing, proportion of ulcers healed within trial period, change of size of ulcer, health-related quality of life, patient length of hospital stay, and adverse events.

CONCLUSION

The results of this study will provide helpful evidence of APRG and CVSD for patients with DFU.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019153289.

Hospitalists' Needs Assessment and Perceived Barriers in Wound Care Management: A Quality Improvement Project

The purpose of this quality improvement project was to determine hospitalists' knowledge, practices, and perspectives related to management of pressure injuries and neuropathic/diabetic foot complications (having a foot ulcer or subsequent development of a foot infection because of a foot ulcer). We also sought to identify resources for and knowledge-based barriers to management of these wounds. This quality improvement effort targeted an interdisciplinary group of 55 hospitalists in internal medicine that consisted of 8 nurse practitioners, 10 physician assistants, and 38 physicians. The site of this initiative was the Johns Hopkins Bayview Medical Center, a 342-bed academic hospital located in the mid-Atlantic United States (Baltimore Maryland). The first phase of our quality improvement project comprised an online survey to identify hospitalists' knowledge, practices, and opinions on inpatient management of pressure injuries and diabetic foot complications. The second phase involved semistructured focus groups attended by hospitalists to identify resource gaps and barriers inferred by survey results. Twenty-nine of 55 (52%) hospitalists responded to the survey; 72% indicated no formal training in wound care. Over 90% had little to no confidence in management of pressure injuries and diabetic foot complications. In a separate ranking section of the survey, respondents selected lack of knowledge/confidence 12 of 29 (41.3%) and resources 9 of 29 (31.0%) as number 1 barriers to wound care. Managing patients with obesity was identified as a second major barrier from 10 of 29 selected options (34.5%). Eighteen of 55 (33%) hospitalists attended focus group sessions acknowledging barriers to wound care that included provider education, information technology, system factors, and interprofessional engagement. Attendees welcomed additional educational and ancillary resource support.

Impact of olive oil and honey on healing of diabetic foot: a randomized controlled trial

Background: This study aimed 1) to examine the impact of honey on diabetic foot; 2) to examine the effect of olive oil on diabetic foot; and 3) to compare the impact of honey and olive oil in the healing of diabetic foot.

Methods: In this randomized controlled trial, 45 patients took part. Patients were randomly assigned to three groups. In the honey group, the wound was dressed using gauzes with honey daily for 1 month. In the olive oil group, the wound was dressed using gauzes with olive oil (4 mL) daily for 1 month. Patients in the control group received usual dressing. Wounds were assessed before and after intervention using the Wagner scoring system and the checklist of diabetic foot healing (where a higher score indicates better wound healing).

Results: Demographic characteristics of patients in the three groups were similar. Mean scores of tissue around the wound, wound grade, wound drainage, and wound healing were similar before intervention in all three groups. After intervention, means score of tissue around the wound, wound grade, wound drainage, and wound healing were significantly higher in patients in the honey and olive oil groups compared to patients in the control group.

Conclusion: The results of this study reveal that honey is as effective as olive oil in the treatment of diabetic foot. Given the few studies on this topic, further investigation is needed.

A nursing metaparadigm perspective of diabetic foot ulcer care

Diabetic foot ulcers (DFUs) are a serious complication of diabetes that impact on the patient, their social environment, overall health, and on nursing practice. Nursing scholars have integrated theories on practice to overcome these problems, but a lack of agreement in the available literature acts as a barrier to implementing these in practice. For that reason, using a nursing metaparadigm as a theoretical framework would assist nurses in managing care purposefully and proactively, thus possibly improving outcomes. There has been little discussion about the nursing metaparadigm in relation to DFU care. This article aims to identify why Fawcett's theory of the nursing metaparadigm is important as a fundamental part of DFU care. Understanding this will help to elucidate the phenomenon of DFUs. Moreover, identifying the elements of the DFU care framework is essential to improve reflective practice and intervention. This article discusses the concept of the nursing metaparadigm and its implications for practice in the care of patients with DFUs.

The effect of short message service (SMS) on knowledge and preventive behaviors of diabetic foot ulcer in patients with diabetes type 2

OBJECTIVE

The present study aimed at evaluating the effectiveness of an educational intervention via mobile cells on foot care knowledge and foot care practices in patients with type 2 diabetes.

MATERIAL AND METHODS

This is an interventional quasi-experimental study carried out in 4 community health centers in Andimeshk City in Iran in 2017. Of 160 patients 80 cases were randomly assigned as intervention group and 80 patients as the control one. A three-section questionnaire completed by a face-to-face interviewing used for data collection before and after the intervention and three months after the education. Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1c) tests were done for both groups in a single laboratory before and three months after training.

RESULTS

The mean age of patients in intervention group was 48.11 ± 9.7 and control group was 47.3 ± 7.9 years. The awareness of the patients related to diabetes foot care, in the intervention group after the training significantly improved (P < 0.001). The mean scores of preventive behaviors of diabetic foot significantly increased in the intervention group (P < 0.001).

CONCLUSION

The findings indicate that educational intervention based on short message service (SMS), resulting in improve foot care knowledge, foot care practices and metabolic control in patients with diabetes type 2.

Diabetic foot ulcer care: a concept analysis of the term integrated into nursing practice

BACKGROUND

Diabetic foot ulcer care demonstrates a beneficial approach to overcoming problems in patients with diabetes. This approach is frequently given but is not always successfully implemented due to its fragmentation amid healthcare providers. What's more, there are a number of different understandings, interchangeable languages and an absence of uniformity overlapping terminologies of meaning for diabetic foot ulcer care. Therefore, analysing the concept of diabetic foot ulcer care is important to provide a wider nursing knowledge, synthesise a greater theoretical model and drive more effective care of diabetic foot ulcer.

OBJECTIVE

This article aimed to analyse how the concept of diabetic foot ulcer care is clearly defined in the relevant evidence as it has several implications in nursing practice.

METHOD

Walker and Avant's (1995) method of concept analysis was systematically used in this study.

FINDINGS

Three critical attributes of diabetic foot ulcer care were determined consisting of assessment, intervention and evaluation. Constructed cases are also presented to differentiate the concept of diabetic foot ulcer care from other concepts. This concept analysis results in the critical attributes of diabetic foot ulcer care, defines an operational definition and describes common goals that improve clarity, consistency and understanding of the concept amid healthcare professionals along with researchers.

CONCLUSION

Effective implementation of the concept of DFU care into clinical nursing practice may undoubtedly improve patient outcomes and prevent the complexities of DFU in the years to come. Future research needs to be developed for evaluating the current use of this concept.

It is not diabetic foot: it is my foot

OBJECTIVE

To examine the experiences of patients with diabetic foot ulcers (DFUs).

METHOD

This qualitative study, using patient interviews, focused on how inpatients receiving treatment for diabetes experience the disease. Patients were selected using a purposive sampling method.

RESULTS

A total of 15 patients participated in the study. Following analysis of patient interviews, four main themes were determined: 'developing diabetic foot', 'living with diabetic foot', 'coping with diabetic foot' and 'expectations'.

CONCLUSION

Most of the patients were afraid of losing their feet and had difficulties in coping with the situation. Patients expected health professionals to understand the difficulties they were experiencing. To better understand the needs and experiences of patients, healthcare professionals should work with these patient groups as part of in-service training programmes. Such programmes should also include therapeutic communication techniques and models for professional patient-client communication.

Factors Associated with Health-Related Quality of Life among Jordanian Patients with Diabetic Foot Ulcer

OBJECTIVE

This study is aimed at determining factors associated with the quality of life among Jordanian diabetic patients with foot ulcers.

METHODS

144 consecutive patients with diabetic foot ulcers aged ≥ 18 years who were attending the diabetic foot clinic at a diabetes-specialized center were included in this study. Health-related quality of life was assessed using two self-administered questionnaires: Diabetic Foot Scale-Short Form (DFS-SF) and Short Form-8 (SF-8).

RESULTS

Patients with diabetic foot ulcer had low mean DFS-SF score and low mean scores on physical and mental component summary scales (PCS8 and MCS8). Males had significantly higher DFS-SF score indicating better health-related quality of life than females (P value 0.038). A patient with stressful life events had significantly lower health-related quality of life using DFS-SF scale and SF-8 summary scales. Patients with peripheral vascular disease (PVD) and patients with obesity had lower DFS-SF and PCS8 quality of life.

CONCLUSION

Patients with diabetic foot ulcer had low quality of life. Female gender, obesity, presence of PVD, and stressful life events were the most important factors associated with lower quality of life in patients with diabetic foot ulcer.

Effect of ointment-based egg white on healing of second- degree wound in burn patients: a triple-blind randomized clinical trial study

OBJECTIVE

Burn wound healing is one of the problems of medical sciences and it is of great importance to find a drug or substance that can heal burn wounds with minimum complications. The present study aimed to evaluate the effect of ointment-based egg white on healing second-degree burn wounds.

MATERIALS AND METHODS

In the present triple-blind clinical trial, a total of 90 patients from Taleghani hospital, Ahvaz, Iran were selected and randomly divided into two groups based on the inclusion criteria. The intervention group was dressed with egg white formulation + silver sulfadiazine cream and the control group was treated with placebo + silver sulfadiazine cream. The burn wound healing process was evaluated on days 1, 7 and 15 by the Bates-Jensen wound assessment tool.

RESULTS

The mean scores of wound healing were decreased (13.75±1.83) in the intervention group when compared to the control (21.51±5.7) on day 15 (p<0.001). The mean duration of wound healing, wound depth, edges, undermining, necrotic tissue, amount of necrosis, exudate type and amount, surrounding skin color, wound induration, peripheral edema, granulation, and epithelialization were significantly decrease in intervention group in comparison with control (p<0.001).

CONCLUSION

The findings of this research showed that egg whites formulation is an appropriate treatment for burn wound healing, reduced above-noted burn wounds' variables. It seems that this treatment, along with the common medicine, improves chronic wound recovery rate and patients' health status.

Potential Biomolecules and Current Treatment Technologies for Diabetic Foot Ulcer: An Overview

BACKGROUND

Diabetic foot ulceration remains a major challenge and is one of the most expensive and leading causes of major and minor amputations among patients with diabetic foot ulcer. Hence the purpose of this review is to emphasize on potential molecular markers involved in diabetic foot ulcer physiology, the efficacy of different types of dressing materials, adjunct therapy and newer therapeutic approach like nanoparticles for the treatment of diabetic foot ulcer.

METHODS

We conducted a systematic literature review search by using Pubmed and other web searches. The quality evidence of diabetic foot ulcer biomolecules and treatments was collected, summarized and compared with other studies.

RESULTS

The present investigation suggested that impaired wound healing in diabetic patients is an influence of several factors. All the advanced therapies and foot ulcer dressing materials are not suitable for all types of diabetic foot ulcers, however more prospective follow ups and in vivo and in vitro studies are needed to draw certain conclusion. Several critical wound biomolecules have been identified and are in need to be investigated in diabetic foot ulcers. The application of biocompatible nanoparticles holds a promising approach for designing dressing materials for the treatment of diabetic foot ulcer.

CONCLUSION

Understanding the cellular and molecular events and identifying the appropriate treatment strategies for different foot ulcer grades will reduce recurrence of foot ulcer and lower limb amputation.

Evaluation of Nurses' Knowledge Levels of Diabetic Foot Care Management

BACKGROUND

Nurses, important members of the diabetes treatment team, have an essential role in the prevention of diabetic foot problems and in the care and education of patients at risk of diabetic foot problems.

OBJECTIVE

The study evaluated the knowledge levels of nurses regarding diabetic foot care management and determined influencing factors.

METHODS

This was a cross-sectional, descriptive study. The research sample comprised 435 nurses who worked in a private hospital. The research data were collected using the "Nurse Information Form" and "Nurses' Knowledge Level Form on Diabetic Foot Management".

RESULTS

It was found that 66% of the nurses did not receive training in diabetic foot care, 80.9% did not educate patients with diabetic foot problems, and 77.5% did not perform foot examinations on diabetic patients.

CONCLUSION

Nurses' knowledge level scores regarding diabetic foot management are adequate, but this knowledge is not used during patient care. In order to facilitate nurses' involvement in diabetic foot management, theoretical and practical training programs should be organized and nurses should be encouraged to participate in these programs.

A systematic review and meta-analysis of patient education in preventing and reducing the incidence or recurrence of adult diabetes foot ulcers (DFU)

BACKGROUND

The World Health Organization (WHO) states that diabetic foot ulcers (DFU) are associated with disability, death among patients with diabetes and substantial costs, if not prevented or managed effectively. The aim here is to examine the effectiveness of patient education in preventing and reducing the incidence or recurrence of adult DFU and amputation.

METHODS

A systematic review and meta-analysis of randomised clinical trials (RCTs) in adults aged 18+ who have diabetes mellitus (type 1 or type 2) or DFU. CINAHL, EMBASE, MEDLINE, PSYCINFO, Cochrane Library and Evidence-Based Nursing, National Library for Health, Medica and Google Scholar were searched. Only English language studies were considered. Databases were searched from their inception to September 2017.

FINDINGS

Six RCTs met the inclusion criteria. Only five RCTs reported on the incidence of DFU whilst only two reported on amputation rates. There was no advantage of combining different educational approaches in preventing/reducing DFU, relative risk (RR) of 0.50 (95%CI 0.21, 1.17) (P = 0.11). Two RCTs based on foot care education alone were compared with usual care; the result showed a non-significant effect (P = 0.57) with high heterogeneity of 77%.Analysis based on intensive versus brief educational approach showed a statistically reduced risk of incidence of DFU in the intervention group when compared to the control group; (RR, 0.37, 95%CI 0.14, 1.01) (P = 0.05) with high heterogeneity of 91%.

INTERPRETATION

The intensive educational intervention was associated with reduced incidence of DFU.

Role of MicroRNA in Proliferation Phase of Wound Healing

Wound healing is a complex biological process that is generally composed of four phases: hemostasis, inflammation, proliferation, and remodeling. The proliferation phase is crucial for effective healing compared to other phases. Many critical events occur during this phase, i.e., migration of fibroblasts, re-epithelialization, angiogenesis and wound contraction. Chronic wounds are common and are considered a major public health problem. Therefore, there is the increasing need to discover new therapeutic strategies. MicroRNA (miRNA) research in the field of wound healing is in its early phase, but the knowledge of the recent discoveries is essential for developing effective therapies for the treatment of chronic wounds. In this review, we focused on recently discovered miRNAs which are involved in the proliferation phase of wound healing in the past few years and their role in wound healing.

Probing community nurses' professional basis: a situational case study in diabetic foot ulcer treatment

Complicated and long-lasting wound care of diabetic foot ulcers are moving from specialists in wound care at hospitals towards community nurses without specialist diabetic foot ulcer wound care knowledge. The aim of the study is to elucidate community nurses' professional basis for treating diabetic foot ulcers. A situational case study design was adopted in an archetypical Danish community nursing setting. Experience is a crucial component in the community nurses' professional basis for treating diabetic foot ulcers. Peer-to-peer training is the prevailing way to learn about diabetic foot ulcer, however, this contributes to the risk of low evidence-based practice. Finally, a frequent behaviour among the community nurses is to consult colleagues before treating the diabetic foot ulcers.