How do Australian podiatrists manage patients with diabetes? The Australian diabetic foot management survey

Quinton, Thomas R; Lazzarini, Peter A; Boyle, Frances M.; Russell, Anthony; Armstrong, David G.

doi:10.1186/s13047-015-0072-y

Cited by 38 publications

(53 citation statements)

References 52 publications

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“…In people with neuropathic DFUs, pressure offloading is arguably the most important of these interventions . There is a long standing clinical tradition of using different offloading devices, footwear, surgery, and other offloading interventions to heal DFUs . Previous IWGDF Guidelines have shown that sufficient evidence is available to support the use of nonremovable knee‐high offloading devices to heal plantar forefoot ulcers, over all other offloading interventions .…”

Section: Introductionmentioning

confidence: 99%

Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)

Bus

Armstrong

Gooday

et al. 2020

Diabetes Metabolism Res

183

432

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the use of offloading interventions to promote the healing of foot ulcers in people with diabetes and updates the previous IWGDF guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical‐scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, we recommend that a nonremovable knee‐high offloading device is the first choice of offloading treatment. A removable knee‐high and removable ankle‐high offloading device are to be considered as the second‐ and third‐choice offloading treatment, respectively, if contraindications or patient intolerance to nonremovable offloading exist. Appropriately, fitting footwear combined with felted foam can be considered as the fourth‐choice offloading treatment. If non‐surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischaemia and for healing plantar heel ulcers. Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes. Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have a foot ulcer and are at risk for infection, hospitalization, and amputation.

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Section: Introductionmentioning

confidence: 99%

Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)

Bus

Armstrong

Gooday

et al. 2020

Diabetes Metabolism Res

183

432

View full text Add to dashboard Cite

show abstract

“…Wound dressing selection is carried out by considering the wound size, depth, infection status, necrosis, amount of exudate and the condition of the surrounding tissue . DFU treatment is focused on screening for loss of protective tissue, adequate vascular perfusion assessment, debridement, infection management and pressure alleviation . Likewise, podiatrists play a significant role in DFU debridement therapy by working intensively with other healthcare professionals including nurses specialised in wound care, vascular surgeons and diabetologists .…”

Section: Resultsmentioning

confidence: 99%

Diabetic foot ulcer care: a concept analysis of the term integrated into nursing practice

Subrata

Phuphaibul

2019

Scandinavian Caring Sciences

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Background Diabetic foot ulcer care demonstrates a beneficial approach to overcoming problems in patients with diabetes. This approach is frequently given but is not always successfully implemented due to its fragmentation amid healthcare providers. What's more, there are a number of different understandings, interchangeable languages and an absence of uniformity overlapping terminologies of meaning for diabetic foot ulcer care. Therefore, analysing the concept of diabetic foot ulcer care is important to provide a wider nursing knowledge, synthesise a greater theoretical model and drive more effective care of diabetic foot ulcer. Objective This article aimed to analyse how the concept of diabetic foot ulcer care is clearly defined in the relevant evidence as it has several implications in nursing practice. Method Walker and Avant's (1995) method of concept analysis was systematically used in this study. Findings Three critical attributes of diabetic foot ulcer care were determined consisting of assessment, intervention and evaluation. Constructed cases are also presented to differentiate the concept of diabetic foot ulcer care from other concepts. This concept analysis results in the critical attributes of diabetic foot ulcer care, defines an operational definition and describes common goals that improve clarity, consistency and understanding of the concept amid healthcare professionals along with researchers. Conclusion Effective implementation of the concept of DFU care into clinical nursing practice may undoubtedly improve patient outcomes and prevent the complexities of DFU in the years to come. Future research needs to be developed for evaluating the current use of this concept.

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“…These devices are more effective when they cannot be removed, such as TCCs and "instant TCCs" (iTCCs), that is cast walkers made irremovable. 2,8 The aim of this project was to increase access to TCCs and iTCCs for patients in a rural and regional setting through implementing a sustainable model of podiatrist-led casting. 6,7 However, TCCs and iTCCs are underutilised as a treatment, especially in rural and regional areas.…”

Section: The Problemmentioning

confidence: 99%

PodCast: A rural and regional service model for podiatrist‐led total contact casting

McLean

Gardner

Perrin

2019

Australian J Rural Health

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Problem: Diabetes-related foot disease causes significant health system costs and is a leading cause of morbidity and disproportionately affects rural populations. Total contact casts or instant total contact casts are gold standard for management of foot ulcerations resulting from diabetes-related foot disease. The aim of this study was to evaluate the impact of a podiatrist-led casting service model within a rural and regional setting. Design: The implementation of the service model was evaluated over a 12-month period using a quality improvement approach, informed by multiple methods.Quantitative and qualitative methods were used. Setting: An outpatient high-risk foot clinic and community-based podiatry services within a large regional health service. The location was central Victoria, servicing rural communities within the Loddon Mallee region. Key measures for improvement: Patient-related data included information relating to demographics, diabetes and foot pathologies. Service-related data included occasions of service, locations and the number and type of casts applied. Strategies for change: Upskilling podiatrists to provide the service in a safe, supportive and sustainable manner and ensuring the podiatrist-led casting service model was sufficiently adaptable for patients to access at the rural sites. Effects of change: Increased access to total contact casts and instant total contact casts, comparable wound healing times to other studies and the model was able to be sustained. Lessons learnt: Podiatrist-led casting resulted in increased utilisation of total contact casts and instant total contact casts. The increased use of instant total contact casts in particular may help address the lack of uptake of this treatment for people with diabetes-related foot disease, thereby improving rural health outcomes. K E Y W O R D Sallied health, diabetes, rural health services delivery, rural workforce development, safety and quality |McLEAN Et AL.

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How do Australian podiatrists manage patients with diabetes? The Australian diabetic foot management survey

Cited by 38 publications

References 52 publications

Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)

Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)

Diabetic foot ulcer care: a concept analysis of the term integrated into nursing practice

PodCast: A rural and regional service model for podiatrist‐led total contact casting

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