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

Australian guideline on wound healing interventions to enhance healing of foot ulcers: part of the 2021 Australian evidence-based guidelines for diabetesrelated foot disease

Pamela Chen1,2,3* , Keryln Carville4 , Terry Swanson5 , Peter A. Lazzarini6,7, James Charles8 , Jane Cheney9, Jenny Prentice10 and on behalf of the Australian Diabetes-related Foot Disease Guidelines & Pathways Project11,12

Abstract

Background: Diabetes-related foot ulceration (DFU) has a substantial burden on both individuals and healthcare systems both globally and in Australia. There is a pressing need for updated guidelines on wound healing interventions to improve outcomes for people living with DFU. A national expert panel was convened to develop new Australian evidence-based guidelines on wound healing interventions for people with DFU by adapting suitable international guidelines to the Australian context.

Methods: The panel followed National Health and Medical Research Council (NHMRC) procedures to adapt suitable international guidelines by the International Working Group of the Diabetic Foot (IWGDF) to the Australian context. The panel systematically screened, assessed and judged all IWGDF wound healing recommendations using ADAPTE and GRADE frameworks for adapting guidelines to decide which recommendations should be adopted, adapted or excluded in the Australian context. Each recommendation had their wording, quality of evidence, and strength of recommendation re-evaluated, plus rationale, justifications and implementation considerations provided for the Australian context. This guideline underwent public consultation, further revision and approval by ten national peak bodies.

* Correspondence: 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。 3 Joondalup Health Campus, Ramsay Healthcare Australia, Perth, Australia Full list of author information is available at the end of the article

© Diabetes Feet Australia 2022 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Results: Thirteen IWGDF wound healing recommendations were evaluated in this process. After screening, nine recommendations were adopted and four were adapted after full assessment. Two recommendations had their strength of recommendations downgraded, one intervention was not currently approved for use in Australia, one intervention specified the need to obtain informed consent to be acceptable in Australia, and another was reworded to clarify best standard of care. Overall, five wound healing interventions have been recommended as having the evidence-based potential to improve wound healing in specific types of DFU when used in conjunction with other best standards of DFU care, including sucrose-octasulfate impregnated dressing, systemic hyperbaric oxygen therapy, negative pressure wound therapy, placental-derived products, and the autologous combined leucocyte, platelet and fibrin dressing. The six new guidelines and the full protocol can be found at: https:// diabetesfeetaustralia.org/new-guidelines/

Conclusions: The IWGDF guideline for wound healing interventions has been adapted to suit the Australian context, and in particular for geographically remote and Aboriginal and Torres Strait Islander people. This new national wound healing guideline, endorsed by ten national peak bodies, also highlights important considerations for implementation, monitoring, and future research priorities in Australia.

Keywords: Diabetes-related foot ulcer, Diabetic foot, Foot ulcer, guideline, Recommendations, Treatment, Wound healing, Wound treatment.