ADIE - Nursing Interventions of Diabetic Foot Ulcer: An Integrative Review of the Literature.

BACKGROUND AND AIMS: Diabetic foot ulcer is recognized as a consequence of peripheral neuropathy and peripheral arterial disease amid individuals with diabetes. As is well known, this situation still remains a crucial problem in nursing practice. Available studies describing an algorithm of inter- related nursing interventions concerned with diabetic foot ulcers are limited. Therefore, this integrative review was aimed to present evidence-based practice for overcoming the complications of diabetic foot ulcer as well as preventing lower extremity amputation. METHODS: This integrative review retrieved scientific literature from PubMed, CINAHL, ProQuest, SAGE Publishing and ScienceDirect databases as published from 2008 to 2017. Thirty-seven studies that met the inclusion criteria were included in this study. RESULTS: Our findings present that neurologic and circulatory assessments were considered as primary steps prior to conducting interventions. Formulating a diagnosis based upon the assessment results is a principal part to determine appropriate interventions. Multiple experimental studies displayed the effectiveness of certain interventions consist of applying wound cleansing, advanced modern wound dressing, topical therapy, offloading, intensive diabetes education and advanced treatment modalities. Hemoglobin A1c, high-density lipoprotein, procalcitonin, the potential of hydrogen of wound fluid, wound size, neurological and circulatory status were determined as the outcomes measurement which must be correctly evaluated. CONCLUSION: This review contributes an algorithm for intervening diabetic foot ulcer thereby generating the given name: ADIE (Assessment, Diagnosis, Interventions, and Evaluation). A collaborative care amid multidisciplinary diabetes team is needed for implementing along with evaluating the feasibility of the study findings. Moreover, active family participation also plays a crucial role to achieve successful management of diabetic foot ulcer at home.

Implementation of the Champions for Skin Integrity model to improve leg and foot ulcer care in the primary healthcare setting.

AIMS: To facilitate evidence-based leg and foot ulcer management through implementation of the Champions for Skin Integrity model to education in primary health care in Australia. BACKGROUND: Leg and foot ulcers are frequently seen wounds in general practice and wound care the most frequently performed activity by practice nurses. The literature reports the lack of evidence-based leg and foot ulcer assessment, management and prevention strategies in this setting, and previous research in regard to confidence and knowledge has indicated that general practice health professionals have the greatest need for education in wound care. DESIGN: Pre-post, nonequivalent group research design. METHODS: The Champions for Skin Integrity model of evidence-based wound management utilised strategies including workshops, development of Champions and use of resources. Pre- and post-implementation health professional surveys and patient clinical audits were completed. Descriptive statistics were calculated for all variables. Paired t tests identified statistically significant differences between the pre/post staff survey data. STROBE guidelines for reporting were followed (See Appendix S1). RESULTS: One hundred nine general practice healthcare professional staff attended the workshops. Significant outcomes were noted in increased levels of confidence in ability to assess, manage and prevent all types of leg and foot ulcers, as well as to apply evidence-based practice and change management following workshops. Pre- and post-skin audits also indicated an increase in evidence-based practices. CONCLUSION: Implementation of Champions for Skin Integrity strategies in this sample of primary healthcare professionals in general practice fostered a positive change in evidence-based wound management, assessment and prevention. RELEVANCE TO CLINICAL PRACTICE: The Champions for Skin Integrity model has supported increases in evidence-based practices in treatment and management of wounds in primary healthcare professionals, similar to the positive outcomes gained in the aged care setting. This is likely to lead to positive outcomes for those with wounds in this setting.

Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial.

OBJECTIVE: Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU). METHOD: A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients' stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial. RESULTS: Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152; p<0.001) who developed a total of 19 heel PUs. CONCLUSION: We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU.

Preventing and managing heel pressure ulceration: an overview.

Heel pressure ulcers are the second most common site for pressure ulceration; although their assessment and treatment can be complex, and they often require additional consideration over and above core principles of pressure ulcer prevention and management. Recent international pressure ulcer prevention and treatment guidelines developed jointly in Europe and the USA have provided greater clarity by achieving international consensus on how to care for patients at risk of heel pressure ulceration, and also on the management of such patients if a pressure ulcer develops. Health professionals should embrace these guidelines and embed them in their everyday clinical practice and within local guidance and protocols to ensure that patients are provided with evidence-based care supported by international collaboration and agreement.

The case for evidence in wound care: investigating advanced treatment modalities in healing chronic diabetic lower extremity wounds.

BACKGROUND: Major complications of diabetes mellitus include lower leg and foot ulcers, which can result in amputation. Further study is needed to determine optimal treatments for these challenging wounds. Growth factor therapy and hyperbaric oxygen (HBO) treatments are 2 advanced therapeutic modalities that hold promise. PURPOSE: This descriptive, retrospective review investigated healing rates of patients with diabetes mellitus and lower- extremity ulcers managed by growth factor therapy and HBO as compared to standard wound care. DESIGN: Retrospective review of medical records. SUBJECTS AND SETTING: We reviewed medical records of 89 patients with diabetes and lower-extremity wounds treated at a major outpatient wound care program in the southwestern United States. METHODS: Patients were categorized according to 4 treatment modalities: (1) standard wound care, (2) growth factor therapy, (3) standard wound care plus HBO, and (4) growth factor therapy plus HBO. Wounds were measured at the start of the analysis and then weekly for a total of 8 weeks. The change in wound volume from the first to the eighth week was recorded. RESULTS: All patient groups demonstrated healing with the patients who received growth factor therapy alone and those who received growth factor therapy and the HBO treatments demonstrating the greatest decrease in wound volume over the 8 weeks. A 2-by-2 factorial analysis of covariance demonstrated that patients who received HBO as part of their wound care regimen demonstrated significantly greater healing than patients who received only standard wound care or growth factor therapy (P < .0001). Although the combination of hyperbaric and growth factor therapy did not show significant synergistic effects for wound healing in this study, it should be noted that the mean size of the wounds in this group was 2.8 times larger than the mean size of the wounds in the other groups. CONCLUSION: Patients managed in a state-of-the-art wound care center experienced progress toward wound healing, regardless of the treatment modality selected. Those who received HBO as part of their wound care regimen healed faster than those who received standard treatment or growth factor therapy.

Research comparing three heel ulcer-prevention devices.

OBJECTIVE: To compare 3 pressure-reduction devices for effectiveness in prevention of heel ulcers in moderate-risk to high-risk patients. DESIGN: A prospective quasi-experimental 3-group design was used. SETTING AND SUBJECTS: A sample of 338 "moderate-risk to high-risk" adult inpatients, ages 18 to 97, at 2 medical centers in South Texas were studied. INSTRUMENTS: The Braden Scale for Pressure Ulcer Risk and investigator-developed history and skin assessment tools were used. METHODS: Subjects were randomly assigned to the High-Cushion Kodel Heel Protector (bunny boot), Egg Crate Heel Lift Positioner (egg crate), or EHOB Foot Waffle Air Cushion (foot waffle). Data are demographics, Braden scores, comorbidities, skin assessments, lengths of stay, and costs of devices. Analyses were Chi-square, analysis of variance, and regression. RESULTS: Of 240 subjects with complete data, 77 (32%) were assigned to the bunny boot group, 87 (36.3%) to the egg crate, and 76 (31.7%) to the foot waffle. Twelve ulcers developed in 240 subjects (5% incidence). Six subjects had only 1 foot. Eleven ulcers were Stage I (nonblanchable erythema), and 1 was Stage II (partial thickness). Overall incidence was 3.9% for the bunny boot, 4.6% for the egg crate, and 6.6% for the foot waffle (not significantly different among groups). The bunny boot with pillows was most cost effective (F[3], N = 240) = 1.342, p

Heel pressure ulcers and ankle brachial pressure index.

There is a substantial body of literature that emphasises the importance of measuring ankle brachial pressure index (ABPI) as part of an holistic assessment for leg ulcers (Scottish Intercollegiate Guideline Network, 1998). However, there is a paucity of research-based evidence to indicate the importance of measuring ABPI as part of an holistic assessment for patients who develop pressure ulcers on their heels. (ABPI is a simple, non-invasive method of identifying arterial insufficiency within a limb.) The importance of identifying the presence of peripheral vascular disease (PVD) in patients who develop pressure ulcers on their heels is discussed, as is the argument for measuring ABPI as part of an holistic assessment for heel ulceration before planning the wound management.

Managing leg and foot ulcers: the role of Kerraboot.

Foot and leg ulcers are chronic wounds characterized by slow or non-healing breakdown of epidermal and dermal tissue on the foot or below the knee. The prevalence is high and ulcers are a significant drain on the NHS in terms of nursing time and cost of dressings, and are incredibly burdensome to the individual patient. This article reviews the evidence for a new wound management system, Kerraboot, designed for the management of leg and foot ulcers. It is a boot-shaped dressing that completely surrounds the ulcer, creating an optimum healing environment. In clinical investigations, Keraboot offered patients relief from pain, was comfortable, easy to use and effectively controlled embarrassing odour, while also saving nursing time. Currently Kerraboot is recommended for the management of diabetic foot ulcers and venous ulcers where the patient is unable to tolerate compression therapy.

An evaluation of the leg and foot ulcer treatment provided in Oslo.

OBJECTIVE: This study set out to gather more information about the treatment of leg and foot ulcers in the community in Oslo, Norway. METHOD: A structured questionnaire on leg and foot ulcer treatment was sent to 173 community nurses in Oslo, of whom 102 responded with data on 145 patients. RESULTS: Of the sample, 55.9% had leg ulcers, 32.2% had foot ulcers and 11.9% both; 26.2% had diabetes. Thirty-four per cent of the patients had not had a diagnosis of leg ulceration. Saline was the preferred cleansing solution. Compression therapy was used on all types of ulcer. Pain was a problem for 52.9% of the patients, of whom 9% did not receive analgesia. CONCLUSION: Nurses and doctors working in this community need to update their knowledge of wound treatments.