Advanced clinical practice within the diabetes multidisciplinary team: a reflective review

Citation: Guttormsen K (2022) Advanced clinical practice within the diabetes multidisciplinary team: a reflective review. The Diabetic Foot Journal 25(2): 24–7

Key words - Advanced clinical practice - Multidisciplinary team - 360-degree feedback

Article points

1. Advanced clinical practice (ACP) is a level of practice delivered by experienced, registered

2. A small, low powered, crosssectional study aimed to demonstrate that multidisciplinary working can help provide sustainable workforce solutions, as well as improve the working of the multidisciplinary team healthcare practitioners

3. 360-degree feedback is an excellent adjunct to clinical supervision

4. Low-powered studies can be scaled up to demonstrate benefit

5. The lower-limb diabetes MDT is an ideal place for

Author：Karl Guttormsen

Karl Guttormsen is Advanced Clinical Practitioner (Diabetes, Endocrinology and General Medicine) North Manchester General Hospital the Manchester Foundation Trust, UK cultivation of ACPs

Advanced clinical practice (ACP) is a level of practice delivered by experienced, registered healthcare practitioners. It incorporates a high degree of autonomy and complex decision making and is underpinned by a master’s level award or equivalent. Most ACP roles within the UK are undertaken by nurses and it is of vital importance that allied health professionals are actively encouraged to develop their skills and knowledge through the lens of the multidisciplinary framework for advanced clinical practice and to actively seek out apprenticeship opportunities. This small, low-powered, cross-sectional study aims to demonstrate that multidisciplinary working can help provide sustainable workforce solutions and improve the workings of the multidisciplinary team (MDT). A total of 100% of respondents agreed that the ACP was able to demonstrate improved MDT working across the four pillars of advanced clinical practice. 360-degree feedback is an excellent adjunct to clinical supervision and its ability to be scaled up makes it a valuable tool in evidencing the impact of advanced clinical practice.

A “Wight” approach to diabetic foot screening?

Stephanie Stanley

Citation: Stanley S (2022) A “Wight” approach to diabetic foot screening? The Diabetic Foot Journal 25(2): 53–7

Key words  - Diabetic foot ulcer  - Podiatrist-led screening service  - Screening

Article points

1. Early identification of patients at high risk of developing diabetic foot ulceration is of paramount importance.

2. The annual screening appointment is an opportunity to check not only neuropathy and vascular supply, but also other issues.

3. The Isle of Wight provides a podiatrist-led screening service and this is currently being reviewed to improve capacity.

Author

Stephanie Stanley Consultant Podiatrist, Clinical, Professional and Operational Lead for Podiatry Podiatry Department St. Mary’s Hospital Parkhurst Road Newport Isle of Wight

Early identification of patients at high risk of developing diabetic foot ulceration is a top priority due to the associate clinical, economic and psychosocial burdens. Routine screening is necessary for preventive care and optimal use of resources. Attendance at the screening appointment gives an opportunity to check not only neuropathy and vascular supply, but also myriad other issues. Involving patients in their own care decreases foot complications, such as ulceration and amputation. The Isle of Wight provides a podiatrist-led screening service and this is currently being reviewed to improve capacity.

Early and ongoing stable glycaemic control is associated with a reduction in major adverse cardiovascular events in people with type 2 diabetes: A primary care cohort study

Martin B. Whyte PhD1 | Mark Joy PhD2 | William Hinton BSc1,2 | Andrew McGovern MD1 | Uy Hoang PhD1 | Jeremy van Vlymen BSc1 | Filipa Ferreira BSc2 | Julie Mount PhD3 | Neil Munro DPhil1 | Simon de Lusignan MD1,2

1 Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK

2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

3 Eli Lilly and Company, Hampshire, UK

Correspondence

Martin B. Whyte, PhD, Department of Clinical & Experimental Medicine, Leggett Building, University of Surrey, Guildford GU2 7WG, UK.

Email: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 Funding information Eli Lilly and Company

Abstract

Aim: To determine whether achieving early glycaemic control, and any subsequent glycaemic variability, was associated with any change in the risk of major adverse cardiovascular events (MACE).

      Materials and Methods: A retrospective cohort analysis from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database—a large, English primary care network—was conducted. We followed newly diagnosed patients with type 2 diabetes, on or after 1 January 2005, aged 25 years or older at diagnosis, with HbA1c measurements at both diagnosis and after 1 year, plus five or more measurements of HbA1c thereafter. Three glycaemic bands were created: groups A (HbA1c < 58 mmol/mol [<7.5%]), B (HbA1c ≥ 58 to 75 mmol/mol [7.5%- 9.0%]) and C (HbA1c ≥ 75 mmol/mol [≥9.0%]). Movement between bands was determined from diagnosis to 1 year. Additionally, for data after the first 12 months, a glycaemic variability score was calculated from the number of successive HbA1c readings differing by 0.5% or higher (≥5.5 mmol/mol). Risk of MACE from 1 year postdiagnosis was assessed using time-varying Cox proportional hazards models, which included the first-year transition and the glycaemic variability score.

      Results: From 26 180 patients, there were 2300 MACE. Compared with group A->A transition over 1 year, those with C->A transition had a reduced risk of MACE (HR 0.75; 95% CI 0.60-0.94; P = .014), whereas group C->C had HR 1.21 (0.81-1.81; P = .34). Compared with the lowest glycaemic variability score, the greatest variability increased the risk of MACE (HR 1.51; 1.11-2.06; P = .0096). Conclusion: Early control of HbA1c improved cardiovascular outcomes in type 2 diabetes, although subsequent glycaemic variability had a negative effect on an individual's risk.

KEYWORDS: computerized, diabetes complications, macrovascular, medical record systems, primary care, type 2 diabetes

Creating a culture of curiosity: How to promote effective safeguarding in the diabetes team and beyond

Charley Samler

Citation: Samler C (2022) Creating a culture of curiosity: How to promote effective safeguarding in the diabetes team and beyond. Diabetes Care for Children & Young People 11: [Early view publication]

Article points

1. There is a need for a shared definition and understanding of how to practice professional curiosity at an inter-agency level.

2. Professional curiosity and inter-agency working rely on one another to thrive.

3. The children and Young Person’s diabetes clinic presents a unique opportunity to practice professional curiosity.

4. Professional curiosity needs to be embedded within all Health and Social Care Professionals’ core training.

5. There is a need for regular safeguarding supervision and simulated workshops to promote ongoing practice of professional curiosity.

Key words

- Diabetes clinic - Inter-agency collaboration - Professional curiosity - Respectful uncertainty - Safeguarding supervision

Authors

Charley Samler is Children’s Diabetes Nurse Specialist, Musgrove Park Hospital, Taunton.

Lower leg improvements in secondary care: Implementing the National Wound Care Strategy Programme

      The National Wound Care Strategy Programme (NWCSP) seeks for improvement in the care of patients with wounds (The National Wound Care Strategy Programme — Lower Limb Recommendations, 2020). The recommendations offer a clear framework for the development for local delivery in clinical care settings. The Skin Integrity Team at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTH) developed clinical pathways through collaboratively system leadership with the Doncaster Place Wound Care Alliance, ensuring secondary care was included and potential and historical barriers overcome, to implement the NWCSP recommendations. Here we describe the process of the translating national recommendations into clinical pathway and the issues that led to the development of a secondary care focused version.

KEY WORDS  Chronic wounds  Lower leg   National Wound Care Strategy Programme (NWCSP)  Secondary care  Wounds

KELLY MOORE Skin Integrity Lead Nurse, Doncaster and Bassetlaw teaching Hospitals NHS Foundation Trust

The prevention of medical-device related pressure ulcers in a Critical Care Unit

This article explores medical-device related pressure ulcers (MDRPU) in an intensive care unit (ICU) at the Royal United Hospitals Bath NHS Foundation Trust (RUH). The data presented outlines a reduction in PU of 66% over a 6-year period and a reduction in MDRPU of 50% over the same period. MDRPU were particularly challenging to prevent in ICU during the COVID-19 pandemic, where there were additional numbers of patients in the ICU with medical devices in place. Additionally, during the COVID-19 pandemic, an increased number of patients in the ICU were nursed prone (face down), adding additional pressure on the facial structure, a range of measures were put in place to avoid those avoidable MDRPU in the ICU at the RUH. Measures focused on skin checking, offloading and rotation of devices, including endotracheal tubes, non-invasive ventilation, nasogastric (NG) and nasojejunal (NJ) tubes and catheters. A specific comfort and pressure care record was developed for ICU to record the assessments of these at risk areas.

KEY WORDS  Pressure ulcer  Device-related  pressure ulcer  DRPU  Medical-device related pressure ulcers

NICOLA HEYWOOD Tissue Viability Nurse Specialist, Royal United Hospitals Bath NHS Foundation Trust.

STEPHANIE WORTHINGTON Tissue Viability Nurse and Critical Care Sister, Royal United Hospitals Bath NHS Foundation Trust.

MICHAELA ARROWSMITH Lead Tissue Viability Nurse, Royal United Hospitals Bath NHS Foundation Trust.

MARGI JENKINS Matron, Critical Care Services, Royal United Hospitals Bath NHS Foundation Trust.

LAURA HERRING Tissue Viability Nursing Assistant, Royal United Hospitals NHS Foundation