Under the microscope: Inpatient care of diabetic foot complications

Joelle Baynham, Debbie Sharman

Authors

Joelle Baynham Podiatrist for Diabetes , Consultant Inpatients, University Hospitals Dorset Foundation Trust; Debbie Sharman, Consultant Podiatrist – Diabetes, Dorset HealthCare University Foundation Trust.

Acute foot complications in people with diabetes continue to be a frequent reason for admission to hospital in the UK and are associated with an increased length of stay. Outcomes have improved where there is access to an inpatient podiatry team. The development of clear referral and management pathways is critical to improving outcomes. An education package supporting simple foot-check risk assessments on admission should also be in place, in order to aid timely identification of people admitted with diabetic foot ulcers. There are increasing numbers of patients for whom further revascularisation options may not be possible, or appropriate. A palliative approach may need to be considered and should be planned for. The progression of advanced clinical practice and consultant-level practice in podiatry lends itself to developing novel future care models. Podiatrists are in a strong position to provide highly advanced autonomous care to inpatients, utilising their expert clinical and leadership skills to enhance future service delivery.

Citation: Baynham J, Sharman D (2022) Under the microscope: Inpatient care of diabetic foot complications. Journal of Diabetes Nursing 26: [Early view publication]

Article points

1. Acute foot complications continue to be a frequent reason for hospitalisation in people with diabetes and are associated with an increased length of stay.

2. Early identification of foot complications on admission, along with clear referral and management pathways, are critical to improving outcomes.

3. The development of advanced and consultant-level practice in podiatry presents opportunities for novel care models and improved access for emergency diabetic foot cases.

Key words  - Diabetic foot  - Inpatient care  - Service delivery

The selection of cushioning and padding materials for effective prophylaxis of medical device-related pressure ulcers: clinical intuition does not always work

Amit Gefen is Professor of Biomedical Engineering and the Berman Chair in Vascular Bioengineering at the Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel

      Currently, the most commonly used dressing materials for the prevention of facial medical device-related pressure ulcers/injuries are hydrocolloids and foams. Often, clinicians who choose one type over the other are unaware of the underlying differences in material behaviours, and the biomechanical considerations and implications of their selection, in particular concerning the compatibility of these dressing types with skin. Accordingly, this article aims to compare the suitability of hydrocolloids versus foams for the specific purpose of facial medical device related pressure ulcer prevention, based on biomechanical considerations which are explained here in a non-technical language. In particular, the alleviation of localised and sustained tissue loads are the most fundamental requirement from any type of prophylactic dressing, and avoiding sharp stiffness gradients between the skin and the protecting dressing serves this purpose. The compressive stiffness matching ratio explained here is an intuitive and easy-to-implement biomechanical performance measure of this skin-dressing stiffness gradient. Specifically, the compressive stiffness of a dressing used for prophylaxis and the compressive stiffness of the skin region covered by the dressing are the most important and relevant properties to consider, given the common techniques of device attachment to skin which apply localised, intense compressive forces to the skin, such as for ventilation masks that are strapped to the head. Based on the above criterion, hydrocolloids exhibit poor biomechanical prophylactic efficacy in protecting healthy skin, and more so, in preventing injuries in fragile or aged skin. Foams, on the other hand, have stiffness properties that closely resemble those of human skin, and, though foam dressings by different manufacturers vary in their specific stiffness properties, some low-stiffness foams provide a near ideal stiffness matching with skin. Wound care professionals should adopt objective, standardised and quantitative research-based approaches in their clinical decision making processes, to grade and then select the optimal dressings for prophylaxis of injuries caused by medical devices. This article discusses an example basic bioengineering measure, i.e., the stiffness matching ratio, which should be demanded by clinicians and disclosed by manufacturers for best-practice.

Single use negative pressure wound therapy (suNPWT) system with controlled fluid management technology — an evaluation of performance

Author: Anette Svensson Henriksson

Anette Svensson Henriksson is Senior Product Developer, Mölnlycke Health Care AB, Gothenburg, Sweden In this article, the results from simulated clinical use tests evaluating the performance of a single use negative pressure wound therapy (suNPWT) system (Avance® Solo NPWT System, Mölnlycke Health Care AB) are presented. This suNPWT system is designed with a negative pressure pump, a distal canister and an absorptive multilayer dressing, and introduces Controlled Fluid Management (CFM) Technology™. The performance was compared to those of two canister-less suNPWT systems, designed around absorptive multilayer dressings and solely relying on the capacity of the dressings to manage fluid through absorption and moisture vapour transmission (evaporation). Method: The technical performances of the suNPWT systems were evaluated with respect to fluid management and delivery of the intended negative pressure using a wound model simulating clinical use on a moderate exudating wound and a 3-day dressing change regimen. Results: With the canister-less suNPWT systems, a loss of performance of the intended negative pressure was observed as saturation of the dressing occurred during the 72-hour test time. In comparison, the canister-based suNPWT system continuously delivered the intended negative pressure to the simulated wound throughout the 72-hour testing time, without any saturation of the dressing observed. Conclusion: The results could be explained by the design of the canister-less suNPWT systems, managing fluid in the dressing only, and that dressing saturation impedes the delivery of the intended negative pressure. In comparison, the canister-based suNPWT system has the capacity to transport excess exudate and infectious material from the dressing to the canister, thereby reducing the risk of dressing saturation.

Screening tool provides insight to the depths of diabetes-related distress

Amanda Dudley, Tiffany Ballentine, Tanya Cohn

Citation: Dudley A, Ballentine T, Cohn T (2022) Screening tool provides insight to the depths of diabetes-related Nursing. 26: [Early view publication]

Article points

1. Each day, people with diabetes are routinely faced with countless decisions regarding the management of their blood glucose levels.

2. This constant management can have emotional, psychological and physiological implications that can lead to diabetes-related distress.

3. If not identified through screening, diabetes related distress can lead to poor health outcomes and decreased self-care. Despite this, assessment is not routinely performed.

Key words - Burnout - Diabetes-related distress - Mental health

Authors Amanda Dudley, Critical Care Nurse; Tiffany Ballentine, Outpatient Surgical Nurse; Tanya Cohn, Associate Professor of Practice and Director of the Doctor of Nursing Practice Program, all at Simmons University, Boston, MA, USA.

      Diabetes-related distress differs from depression as it develops from the mental and emotional burden that comes from the constant management of diabetes. Despite the increased awareness and knowledge of diabetes-related distress, patients with diabetes are not routinely screened during clinic visits. In order to potentially encourage providers to implement the 17-item Diabetes Distress Scale (DDS-17) into practice and clinic appointments with patients, the authors researched and analysed results from voluntary and anonymous participants with diabetes, aged 18 years and older, who completed demographic survey questions and the DDS-17. The results revealed that areas of statistically significant distress can be found in people recently diagnosed with diabetes and occurs more often in those with type 1 diabetes compared with type 2 diabetes.

The Legs Matter campaign: buzzing about legs and feet!

MARGARET SNEDDON Chair, British Lymphology Society, Member of Legs Matter Coalition, Hon. Sen Res Fellow, University of Glasgow

Frailty Syndromes: should wounds be considered an additional syndrome?

SAMANTHA HOLLOWAY Academic Editor, Wounds UK; Reader, Programme Director, Cardiff University School of Medicine, Cardiff

"...chronic wounds could be considered an additional frailty syndrome based partly on the notion of skin failure"