Effectiveness of structured teaching program on knowledge and attitude toward foot care

Objective:The study was aimed to assess the knowledge and attitude toward foot care and evaluate the effectiveness of structured teaching program(STP)on the knowledge and attitude of patients with diabetes mellitus regarding foot care.Materials and Methods:A preexperimental research design was used in this study,which was conducted in medical-surgical wards of a secondary hospital in Northeast India,Nagaland.A total of 30 subjects were recruited by consecutive sampling technique.A closed-ended structured questionnaire and 5-point Likert scale was used to assess knowledge and attitude toward foot care.A STP was administered after which posttest was done after 24 h.Results:The majority(86.6%)of the participants in the pretest had inadequate knowledge and 80%had negative attitudes toward foot care.After STP,70%had moderately adequate knowledge and 53.3%had a positive attitude regarding foot care.The structured teaching program was effective in improving the knowledge and attitude at P<0.01 which is highly significant and there was a significant association between the pretest level knowledge and duration of diabetes at P<0.01.Conclusion:STP was effective in enhancing the level of knowledge and attitude toward foot care among diabetic inpatients.This type of interaction can be organized at regular intervals to reinforce knowledge and attitude toward foot care among inpatients.

Ten Rules of Foot Care—The Development of a Short Questionnaire for Patients with Diabetes

Objective: The aim of this study was to develop and validate a questionnaire for patients with diabetes to assess the foot self-care. Methods: A validation study was carried out in a sample of 200 patients with diabetes. Item analyses included the assessment of difficulty index, discrimination capacity and the correlation of items with the total score of the questionnaire. Factor analysis was used to test construct validity. Test-retest reliability was assessed with a sample of 31 patients. Criterion validity was determined by comparing the scores of patients with a history of foot ulcers with the scores of patients without this complication. Results: The internal consistency assessed by the Cronbach’s alpha (0.731) and test-retest reliability (r = 0.714, p = 0.001) for all sections were acceptable. Factor analysis revealed three factors: foot care, footwear and foot-damaging behavior, which explained 54.34% of the variance. All items had factor loading of greater than 0.4. Patients with diabetic neuropathy had a lower score after completing the foot care education questionnaire (Mann-Whitney U, p < 0.001). Conclusion: This questionnaire meets the reliability and validity conditions necessary for its application in our patients with diabetes.

Factors related to changes in foot status and foot care in patients with diabetes mellitus participating in an exercise health education program

Purpose: To identify factors related to changes in foot status and foot care in patients with diabetes mellitus participating in an exercise program. Methods: The subjects were 21 patients with Type 2 diabetes mellitus (8 males, 13 females). The mean age of the patients was 62.3 ± 12.5 years old. Foot status, physical measurements and daily activities were monitored and several surveys were performed. Results: Changes in foot status were significantly positively correlated with walking at normal speed (r = 0.54, p < 0.05) and fast speed (r = 0.68, p p < 0.05). Foot care showed a significant negative correlation with burden of diet therapy (r = -0.48, p < 0.05) and a significant positive correlation with the self-efficacy of diet therapy (r = 0.65, p < 0.01). Conclusions: Subjects who were fast walkers showed greater changes in foot status. Poor foot care behavior is also related to greater changes in foot status. Regular interventions for foot care are important to improve self-care behavior during an exercise program.

Assessment of Foot Care Knowledge among Diabetic Amputees at National Orthopaedic Hospital Enugu

Diabetics with unilateral lower extremity amputation (LEA) have an increased risk of contralateral re-amputation. Foot care knowledge and practice has been shown to reduce the incidence of amputation. The study aims to assess the level of foot care knowledge among diabetics with unilateral LEA. Method: A questionnaire based study involving diabetics with unilateral LEA from August 2015 to August 2017. Demographic data and level of foot care knowledge were assessed. Associations between age, gender, educational level, prior amputation and duration of diabetes with level of foot care knowledge were investigated. The presence of peripheral neuropathy in the contralateral leg was also assessed. Results: A total of 64 patients had unilateral LEA within this period, but only 42 patients completed the study. Twenty-four, 24 (57.1%) were males while 18 (42.9%) were females. Mean age was 58.3 years (SD = 12.0). Fifteen, 15 (35.7%) had secondary, 15 (35.7%) had tertiary education, while 3 (7.1%) and 9 (21.4%) had none and primary education respectively. Below knee amputation (BKA) was the commonest (78.6%), and 35.7% have had a prior amputation. Peripheral neuropathy was present in 71.4% of cases. No participant had a good level of foot care knowledge, while 13 (31%) have a fair knowledge and 29 (69%) have poor knowledge. Only 18 (42%) said they have been taught on foot care. Only duration of diabetes and educational level were significantly associated with level of foot care knowledge. Conclusion: Diabetics with unilateral LEA have poor knowledge of foot care and a high prevalence of peripheral neuropathy. Efforts at education of these susceptible cohorts should be intensified.

Foot Care Practices among Type 2 Diabetics Mellitus Patients Attending Diabetes Clinics in Embu County, Kenya

Diabetes mellitus has become a global epidemic of 21st century with dispro- portionately high socioeconomic burden in the developing world. Foot ulcerations secondary to peripheral neuropathy and peripheral vascular disease have led to devastating health outcomes including amputations. A descriptive survey targeting a sample size of 301 was drawn from the selected health facility. Majority of the respondents were female and aged between 40 and 70 years old. The duration that a patient had lived with diabetes, history of smoking and respondents age was significantly associated with foot ulcers at P-value bare foot in and out of the house, breaking into new shoes, poor inspection of feet were associated with the development of foot ulcers while dressing of blisters with sterile dressings was associated with the prevention of foot ulcers.

An Evidence-Based Policy Brief Improving Foot Care in Diabetic Patients: Reduces Amputations

Included: &bull;Description of a health system problem;&bull;Possible options for addressing this problem;&bull;Strategies for implementing these options. Not included: recommendations This policy brief does not make recommendations regarding which policy to choose. Who is this policy brief for? Policymakers, healthcare professionals, training institutions and other stakeholders that have an interest in the problem addressed in this evidence-based policy brief, Community leaders, non-governmental organizations. Why was this policy brief prepared? To inform discussions about health policies and programmes in relation to diabetic foot care by summarising relevant literature available on foot care in diabetic patients and possible solutions to reduce amputations. What is an evidence-based policy brief? Evidence based policy briefs bring together global research evidence (from systematic/literature reviews) and local evidence to inform discussions about health policies and programmes. Systematic review: A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyze data from this research. Executive Summary: The evidence presented in this executive summary is summarized from a full brief.

Effectiveness of a Self-Foot-Care Educational Program for Prevention of Diabetic Foot Disease

Objective: To verify the effectiveness of a “self-foot-care educational program (SFCEP)” for prevention of type 2 diabetes foot disease. Methods: A single-center, randomized and controlled trial was conducted. Fifty-five patients with type 2 DM, 40 - 75 years of age who were asked to return for a follow-up hospital visit, were allocated to either an SFCEP group (n = 29) or a conventional education program (CEP) group (n = 26). Both of the groups were given foot-care education, monthly for four times in the SFCEP group and in the CEP group one time only by a printed leaflet. The two groups had no statistically significant differences in patient background of the type 2 diabetes history. We evaluated removal rate of skin debris, and the symptoms and conditions of the feet. Results: Between the SFCEP and CEP there were significant differences in removal rate of skin debris (p Conclusion: This study strongly suggests the effectiveness of SFCEP in preventing the occurrence or worsening of diabetic foot diseases.

Effect of Foot Self-Care Behavior According to Severity of Diabetic Neuropathy in Japanese Patients with Diabetes

PURPOSE: Diabetic patients with severe diabetic neuropathy often have hypoesthesia and numbness. This study evaluated foot self-care behavior according to severity of diabetic neuropathy. METHODS: We used a hand-held nerve conduction test device DPN check (HDN-1000, Omron) to evaluate severity of diabetic neuropathy. Foot self-care was evaluated using the Japanese SDSCA (the Summary of Diabetes Self-Care Activities measure). Foot self-care comprised visual inspection, washing, wiping interdigital areas, and checking shoes, and was scored according to the number of days self-care which was performed in the previous week. RESULTS: The study evaluated 103 diabetic patients (age: 65.7 years, diabetes duration: 13.9 years, HbA1c: 7.3%). Total scores (out of 28 points) for self-care behavior according to neuropathy severity were 11.8 (Normal: n = 54), 10.6 (Mild: n = 27), 13.3 (Moderate: n = 17), and 10.8 (Severe: n = 5). Foot self-care scores were low in all groups, with particularly low scores in those with severe neuropathy. However, no statistically significant differences were observed. CONCLUSIONS: Foot self-care is essential in diabetes because lesions are more likely to occur in severe neuropathy. Living alone and the presence of recurrent foot lesions are associated with poor survival prognosis. Accordingly, foot-care intervention must take neuropathy severity and lifestyle factors into account. The severity of diabetic neuropathy must be determined and foot-care intervention should take lifestyle factors into account.

Relationship between Self-Care and Hand Foot Syndrome Specific Quality of Life in Cancer Patients

Purpose: The purpose of this study was to describe adherence to self-care for hand-foot syndrome (HFS) and the relationship between self-care and health-related quality of life (QOL). Methods: A cross-sectional study was conducted on 105 consecutive outpatients with HFS. To assess self-care for HFS and QOL, the participants were asked to complete self-care and HFS-14 (hand-foot syndrome specific QOL) questionnaires, respectively. Multiple regression models were used to identify the relationship between self-care and QOL. Results: Adherence to self-care for HFS was low, less than 50% for most of the items. Multivariate analysis revealed that poorer self-care (βs = -0.19;P = 0.03), depressive symptoms (βs = 0.43;P βs = 0.20;P = 0.04) were independent predictors of poorer QOL scores. Conclusions: We have identified a need for further research to develop effective programs of self-care in HFS.

CICARE沟通模式联合小丑照护在居家隔离手足口病患儿门诊健康教育中的应用

目的探讨CICARE沟通模式联合小丑照护在居家隔离手足口病(HFMD)患儿门诊健康教育中的应用效果。方法选取2018年1月至2019年9月经南阳医学高等专科学校第一附属医院门诊确诊并实施居家隔离的90例HFMD患儿及其家长为研究对象。按照收治时间的先后顺序,分为对照组和研究组,每组45例。对照组患儿男27例,女18例,年龄(4.18±0.39)岁;研究组患儿男24例,女21例,年龄(4.10±0.43)岁。对照组实施传统模式门诊宣教,研究组在对照组基础上实施CICARE沟通联合小丑照护。记录两组患儿相关临床症状的改善情况,采用儿童孤独量评估患儿孤独感水平,自制HFMD治疗依从性调查问卷评估患儿治疗依从性,采用《HFMD儿童家长疾病认知表》评估家长对疾病知识的掌握水平,根据第4周随访情况评价家长居家遵医行为的执行状况,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估家长焦虑、抑郁水平。结果研究组患儿溃疡痊愈时间、皮疹消退时间、食欲不振消失时间、腹泻停止时间、退热时间及口腔黏膜愈合时间均低于对照组,差异均有统计学意义(均P<0.001);研究组的治疗依从性总分[(9.83±1.24)分比(18.79±1.56)分]、孤独感评分[(28.70±3.18)分比(39.20±6.15)分]均低于对照组,差异均有统计学意义(均P<0.001);干预1个月后,研究组家长居家隔离认知情况得分、居家隔离遵医率均高于对照组,SAS、SDS评分均低于对照组,两组比较差异均有统计学意义(均P<0.05)。结论CICARE沟通模式联合小丑照护干预,利于缩短居家隔离HFMD患儿各症状的改善时间,缓解其孤独感,避免自我隔绝,促进遵医行为,夯实治疗效果,提高患儿及其家长的隔离依从性,防止交叉感染,保障患儿健康。

Literature review on the management of diabetic foot ulcer

Diabetic foot ulcer(DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime.Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it's suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications.

The Effectiveness of Concept Mapping as an Educational Nursing Intervention Strategy to Handle Diabetic Foot: Integrative Review

Introduction: Concept map is used as a teaching strategy, where nursing uses this method often to learn more effectively and to be able to apply knowledge when working with diabetic patients. Objective: The aim of this review is to examine all the published articles related to the effectiveness of concept mapping as an educational nursing intervention strategy to handle diabetic foot from 2010-2019. Methodology: Integrative review design in reviewing pertaining literature. Key words related to research were used, database obtained from Cochrane library, MEDLINE, PubMed, Science Direct, Cumulative Index Nursing and Allied Health Literature (CINAHL), ProQuest and Ovid databases were searched, covering the period 2010 to 2019. Other Studies were included if they were related to the effectiveness of concept mapping as an educational nursing intervention strategy to handle diabetic foot. Results: Reveled that concept mapping is a very crucial education tool for both nurses and patients. It is used by nurses to teach diabetic patients how to prevent diabetic foot ulcer, as well as to understand how to organize information and understand the facts. Conclusion: This review confirmed that there are growing confirming literatures about the application of concept maps as an effective nursing strategy. It that can be used by nurses and other health care professionals, to maintain healthy feet and prevent further complications such as bruises, cuts and sores.

Effect of Internet technology on extended care in elderly patients with diabetic feet

Objective： To evaluate the effect of Internet technology on continuing nursing in elderly patients with diabetic feet, Method： From January 2015 to July 2016,12 elderly patients with diabetic foot ulcers were enrolled from the Endocrinology Department in our hospital. We used ＂WeChat＂, ＂E nursing＂ and other Internet technologies to perform remote extended care and to observe the foot ulcer outcomes. Results： All foot ulcers healed with a wound healing time between 38 and 73 days （average 57.08 ~ 12.69 days）. Patients did not need to travel long distances to seek medical treatment for foot ulcers, improving their satisfaction. Conclusions： The implementation of extended care for elderly patients with diabetic foot ulcers was based on the application of Internet technology. It is helpful to facilitate medical treatment, share high quality health resources and promote disease rehabilitation.

糖尿病足坏疽患者一例的居家安宁疗护实践

本文总结1例糖尿病足坏疽患者进行中医药特色的居家安宁疗护实践体会,护理要点包括入户指导家属对患者进行糖尿病足照护、帮助患者建立预立医疗计划、为患者及家属提供家庭尊严疗法、灵性照护、哀伤抚慰等,使患者有尊严、无遗憾、安详地离世;同时,减轻家属照护压力,缩短其哀伤过程。

1例糖尿病足溃疡合并骨髓炎病人呈多处窦道型创面护理

总结1例糖尿病足溃疡合并骨髓炎病人呈多处窦道型创面处理方法。以糖尿病足专科护士为主导,依托多学科团队合作,动态综合评估及干预影响病人创面愈合的全身及局部因素,沿着窦道方向选用“纵向小切口”+“锐性清创”方法,先后灵活调整采用“内置引流”“外压闭合”的封闭负压引流治疗方法、联合使用胶原蛋白敷料治疗方案,可有效促进创面肉芽组织生长,加快窦道型创面愈合,历经60 d,共13次换药处理,病人全身感染情况得到良好控制,创面完全愈合,并恢复早期行走功能,最终改善病人生活质量。

Clinical Care: Hallux Amputation Due to Disruption of Diabetes Services in COVID-19 Pandemic, Peshawar, Pakistan

Diabetes mellitus is one of the most prevalent endocrine disorders associated with macro and micro vascular complications. Lower limb complications associated with diabetes including Diabetic Foot Ulcers (DFU) are a major public health issue worldwide. Novel Coronavirus (COVID-19) is a strain of coronavirus which causes illness in animals and humans. COVID-19 has significantly affected people with chronic medical conditions such as diabetes, hypertension, cardiovascular disease and cancer with severe illness and worse outcomes as well as disruption of their routine medical care provision. We presented a case-study of 59-year-old patient with diabetes and hypertension, with an unexpected DFU complication that resulted in big toe amputation. Therefore it is vital for us as health care professional to find innovative ways to ensure the continuity of medical care/service provision along with the fight of COVID-19.

融合病房糖尿病足合并多发皮肤溃疡继发颅骨外露患者的多学科协作护理

总结1例融合病房糖尿病足合并多发皮肤溃疡继发颅骨外露患者的多学科协作护理体会。基于融合病房一站式护理模式,制订全疗程针对性护理方案,包括:头部扩创筋膜皮瓣转移术后皮瓣护理、双足扩创负压术后预防复发护理等个性化创面护理方案,助力创面愈合、预防溃疡复发;全程血糖控制管理;完善营养提升计划;以问题为导向的院外延续护理。经过多学科一站式融合护理,患者病情好转出院。随访3个月,患者血糖控制良好,足部和头顶溃疡愈合。

北京市某社区2型糖尿病患者足部护理知识与行为状况调查及影响因素分析

目的调查北京市新街口社区2型糖尿病患者足部护理知识与行为状况并分析其影响因素。方法采用方便取样法选取北京市新街口社区的278例糖尿病患者进行问卷调查,调查内容包括患者的一般资料、足部护理知识和行为。结果278例患者的足部护理知识平均得分为(71.65±14.59)分,整体处于中等水平,足部护理行为平均得分为(48.83±8.83)分,整体处于较差水平。多元逐步回归分析结果显示,性别、病程、是否接受过足部护理教育均为社区糖尿病患者足部护理知识得分、足部护理行为得分的独立影响因素(P<0.05)。Pearson相关分析结果显示,社区糖尿病患者足部护理知识与足部护理行为呈正相关(r=0.593,P<0.001)。结论北京市该社区糖尿病患者足部护理知识水平中等,足部护理行为状况不容乐观。社区医护人员应加强足部护理健康教育,提升患者的足部护理知识水平和足部护理行为依从性,同时应关注男性、病程较短的糖尿病患者,以减少糖尿病足的发生。

老年糖尿病足围手术期护理使用细节护理的临床效果分析

目的细节护理在老年糖尿病足患者围手术期的成效分析。方法回顾性选取2020年1月—2023年10月济南市市中区人民医院收治的60例老年糖尿病足患者的临床资料,根据不同护理方法分为对照组和观察组,各30例。对照组行常规护理,观察组行细节护理,对比两组老年糖尿病足患者的不良事件发生率、护理满意度、情绪状况(焦虑、抑郁评分)。结果与对照组相比,观察组不良事件发生率更低,差异有统计学意义(P<0.05)。观察组的护理满意度高于对照组,差异有统计学意义(P<0.05)。观察组汉密尔顿焦虑量表评分、汉密尔顿抑郁量表评分均低于对照组,差异有统计学意义(P均<0.05)。结论细节护理在老年糖尿病足患者围手术期的价值高,对调节不良情绪、降低不良事件发生率均有较好的效果。

广西重症手足口病患儿接受重症监护及出现死亡的危险特征分析

目的:分析重症手足口病(HFMD)患儿在不同临床症状和体征下,进入重症监护室(ICU)及死亡的风险,为重症HFMD患儿接受重症监护与不同临床转归的危险体征识别提供参考。方法:在2014-2018年间,通过现场调查方法,对广西各县(市、区)重症住院的HFMD确诊患儿进行了连续的个案调查;采用Epidata软件对调查资料进行双录入;使用二分类logistic回归分析,比较重症HFMD患儿不同的临床症状和体征与其死亡或被收入ICU的风险(比值比,OR),明确哪些临床症状体征导致患儿更可能进入ICU及更容易死亡。结果:2014—2018年共调查广西各县(市、区)重症HFMD病例1 500例,男女性别比例为1.78∶1;发病年龄中位数为1.85岁(0~11岁)。与未出现这些症状的患儿相比,共济失调、谵妄、口唇紫绀、面色苍灰、嗜睡、无力麻痹、肢体抖动、易惊是患儿进入ICU的危险症状体征(OR分别为4.924、4.515、2.781、2.750、2.311、2.162、2.139、1.361)。血性泡沫痰、呼吸浅促、面色苍灰、口唇紫绀、呕吐是预示死亡风险增加的危险症状(OR分别为19.045、5.438、3.175、3.031、2.621)。结论:重症HFMD患儿如出现共济失调、谵妄、口唇紫绀等症状,其病情进一步发展为危重症的概率更高,并需接受重症监护治疗;如出现血性泡沫痰、呼吸浅促、面色苍灰、口唇紫绀、呕吐等症状时,应重点关注病情是否恶化而导致死亡。