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

2019 ◽  
Vol 16 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Sumarno Adi Subrata ◽  
Rutja Phuphaibul ◽  
Nirobol Kanogsunthornrat ◽  
Apinya Siripitayakunkit
Keyword(s):  
Diabetic Foot ◽  
Topical Therapy ◽  
Experimental Studies ◽  
Density Lipoprotein ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Integrative Review ◽  
Treatment Modalities ◽  
Nursing Interventions ◽  
Wound Fluid

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.

Effects of pH on the Antibiotic Resistance of Bacteria Recovered from Diabetic Foot Ulcer Fluid

2018 ◽  
Vol 108 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Carla D. McArdle ◽  
Katie M. Lagan ◽  
David A. McDowell
Keyword(s):  
Antibiotic Resistance ◽  
Diabetic Foot ◽  
Bacterial Infections ◽  
Clinical Decision Making ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Decision ◽  
Wound Fluid ◽  
Ph Values ◽  
Diabetic Foot Infections

Background: This study investigated the resistance of bacteria isolated from diabetic foot ulcers (DFUs) to antibiotics frequently used in the management of the diabetic foot infections, at a range of pH values (pH 6.5, 7.5, and 8.5) known to exist in DFU wound fluid. This study aimed to determine whether changes (or atypical stasis) in wound fluid pH modulate the antibiotic resistance of DFU isolates, with potential implications in relation to the suppression/eradication of bacterial infections in DFUs. Methods: Thirty bacterial isolates were recovered from DFU wound fluid, including Staphylococcus spp, Staphylococcus aureus, Escherichia coli, Streptococcus spp, Pseudomonas spp, and Pseudomonas aeruginosa. The resistances of these isolates to a panel of antibiotics currently used in the treatment of infected or potentially infected DFUs, ie, ciprofloxacin, amoxicillin-clavulanate, doxycycline, and piperacillin-tazobactam, at the previously mentioned pH values were determined by a modification of the Kirby-Bauer assay. Results: The resistance of DFU isolates to clinically relevant antibiotics was significantly affected by the pH levels in DFU wound fluid. Conclusions: These findings highlight the importance of a more comprehensive understanding of the conditions in DFUs to inform clinical decision making in the selection and application of antibiotics in treating these difficult-to-heal wounds. The scale of the differences in the efficacies of antibiotics at the different pH values examined is likely to be sufficient to suggest reconsideration of the antibiotics of choice in the treatment of DFU infection.

scholarly journals Diabetic foot ulcer wound fluid: the effects of pH on DFU bacteria and infection

2015 ◽  
Vol 8 (S1) ◽  
Author(s):  
Carla McArdle ◽  
Katie Lagan ◽  
Sarah Spence ◽  
David McDowell
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Wound Fluid ◽  
Effects Of Ph

scholarly journals Designing a Logistic Regression Model for a Dataset to Predict Diabetic Foot Ulcer in Diabetic Patients: High-Density Lipoprotein (HDL) Cholesterol Was the Negative Predictor

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Seyyed Amir Yasin Ahmadi ◽  
Razieh Shirzadegan ◽  
Nazanin Mousavi ◽  
Ermia Farokhi ◽  
Maryam Soleimaninejad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Diabetic Foot ◽  
Logistic Regression Model ◽  
Density Lipoprotein ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Hdl Cholesterol ◽  
Diabetic Patients ◽  
Final Model ◽  
Negative Predictor

Objectives. Although the risk factors for diabetic neuropathy and diabetic foot ulcer have been detected, there was no practical modeling for their prediction. We aimed to design a logistic regression model on an Iranian dataset to predict the probability of experiencing diabetic foot ulcers up to a considered age in diabetic patients. Methods. The present study was a statistical modeling on a previously published dataset. The covariates were sex, age, body mass index (BMI), fasting blood sugar (FBS), hemoglobin A1C (HbA1C), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), insulin dependency, and statin use. The final model of logistic regression was designed through a manual stepwise method. To study the performance of the model, an area under receiver operating characteristic (AUC) curve was reported. A scoring system was defined according to the beta coefficients to be used in logistic function for calculation of the probability. Results. The pretest probability for the outcome was 30.83%. The final model consisted of age ( β 1 = 0.133 ), BMI ( β 2 = 0.194 ), FBS ( β 3 = 0.011 ), HDL ( β 4 = − 0.118 ), and insulin dependency ( β 5 = 0.986 ) ( P < 0.1 ). The performance of the model was definitely acceptable ( AUC = 0.914 ). Conclusion. This model can be used clinically for consulting the patients. The only negative predictor of the risk is HDL cholesterol. Keeping the HDL level more than 50 (mg/dl) is strongly suggested. Logistic regression modeling is a simple and practical method to be used in the clinic.

Avoidance of lower limb amputation from a diabetic foot ulcer: The importance of multidisciplinary practice and patient collaboration

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 19-27
Author(s):  
Margaret Mungai ◽  
Emmy Sirmah
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Limb Amputation ◽  
Nursing Interventions ◽  
Multidisciplinary Practice ◽  
Sugar Levels ◽  
Care Nursing

This article explores wound care nursing interventions and inter-professional collaboration for a patient referred with a stage 3 diabetic foot ulcer (DFU). To the patient’s distress, he had been informed that he may require an amputation due to the severity of his DFUs. On initial presentation, the patient was symptomatic for peripheral neuropathy, infection and hyperglycaemia. The left lower limb was oedematous and there was a DFU at the metatarso-phalangeal joint of the big toe on his left foot secondary to haemorrhagic callus. Progressive healing of the DFU was realised over time by repetitive debridement; incision and drainage of the DFUs; antibiotic therapy; appropriate footwear; dietary instructions; control of the blood sugar levels (BSLs); and patient and family education. Wound care nursing interventions were applied in conjunction with medical management of the DFUs. The DFUs were managed using a locally made, two-part zinc oxide gauze dressing known as the Unna boot. A family member was instructed how to continue applying the dressings at home in between clinic visits. Complete wound healing was eventually achieved within four months, thus avoiding the need for amputation.

Comparing the Efficacy of Viable Cryopreserved Placental Membrane for the Treatment of Wounds of Diverse Etiologies

2016 ◽  
Vol 106 (sp1) ◽  
pp. 12-12
Author(s):  
Derek S. Anselmo ◽  
Marc Karpo ◽  
Ebony Love ◽  
Tracey Vlahovic
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Stem Cell ◽  
Pyoderma Gangrenosum ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Treatment Modalities ◽  
Appreciable Amount ◽  
Area Reduction

INTRODUCTION AND OBJECTIVES: The benefits of using amniotic tissue in skin regeneration are well documented. Today, cryopreservation technology allows for better availability and maintenance of mesenchymal stem cells. This is of particular interest in treating the diabetic foot ulcer as this population has fewer mesenchymal stem cells. The objective of this case series investigation was to compare the efficacy of cryopreserved human amniotic stem cells in treating foot wounds of different etiologies. We will present data and case photos for a diabetic foot ulcer, venous leg ulcer, arterial ankle ulcer, and a pyoderma gangrenosum ulcer METHODS: Cryopreserved human amniotic stem cell grafts were applied to patients with chronic ulcers of different etiologies that had been subjected to at least 4 weeks of standard wound care and did not show adequate clinical progress. Wound area was recorded and photographed on weekly basis. Area reduction was charted over time and the results of each individual case were compared to one another. RESULTS: All ulcers displayed results that well exceeded the established parameters of weekly healing rates for effective wound treatment modalities. • Pyoderma gangrenosum displayed the poorest response to treatment. However, it is worth noting that the patient was not compliant in the prescribed adjunctive treatment regimen but managed to achieve 64% wound reduction. • All ulcers showed the largest appreciable amount of healing in both total area reduction and week-to- week closure percentage after the first application. CONCLUSIONS: Cryopreserved human amniotic stem cell grafts can aid in the decreasing the time to closure of various types of lower extremity ulcerations. The therapy is a clinically viable option for physicians to consider when formulating a treatment plan for a patient with an ulcer.

scholarly journals To study the effect of oral vitamin D supplements on wound healing in patient with diabetic foot ulcer and its effect on lipid metabolism

2020 ◽  
Vol 11 (2) ◽  
pp. 2701-2706
Author(s):  
Ajoinish Kamble ◽  
Ranjit S. Ambad ◽  
Mangesh Padamwar ◽  
Anupam Kakade ◽  
Meenakshi Yeola
Keyword(s):  
Vitamin D ◽  
Wound Healing ◽  
Diabetic Foot ◽  
Density Lipoprotein ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Vitamin D Levels ◽  
Group A ◽  
Vitamin D Supplements ◽  
Group B

To Critically Assess the effect of oral vitamin D supplements on wound healing in a patient with diabetic foot ulcer and its impact on lipid metabolism. This is a single-Centre prospective randomised, control-controlled study was conducted in Department of Surgery Datta Meghe Medical College, Hingna, Nagpur, in collaboration with Datta Meghe Institute of Medical Sciences (DMIMS) Deemed to be University from June 2019 TO March 2020. A total of sixty patients were included in this study. A randomised grouping was done, group A vitamin d supplements and group B as an x-control group. In the group, A vitamin D levels were significantly increased after 12 weeks of intervention as compared to baseline while in group B, no change was seen after the intervention. There was a significant change in HbA1c level after intervention as group A vs group B. similar results were seen in total cholesterol levels after intervention in group A, and group B. Wound surface area was (29.83±15.02 vs 21.76±11.30, p=0.02) in group A and (25.06±14.02 vs 21.3±13.19, p=0.28) in group B respectively. The level of high-density lipoprotein in the group was significantly lower in level when compared to group A after 12 weeks of intervention. No significant changes were seen in the triglycerides level in group A and group B., A comparison of group A vs group B after 12 weeks of intervention, was done. It revealed that Vitamin D Glycosylated total haemoglobin cholesterol, High-density lipoprotein and Wound surface area, significantly improved. At the same time, there was no change seen in triglycerides levels in both the group.After intervention with vitamin D supplements for 12 weeks among patients with diabetic foot ulcer had a good result and beneficial effect on glucose metabolism, vitamin D levels, lipid profile and wound healing

A Single Case Study of Diabetic Foot Ulcer treated with Vrana Dhoopana and Kshara Picchu

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Dr.Shruthi P ◽  
Dr.Shailaja SV
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Single Case ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Treatment Modalities ◽  
Common Disease ◽  
Lower Leg Amputation ◽  
Leg Amputation

In present scenario due to the sedentary lifestyle, diabetes mellitus has become common disease. Diabetic foot ulcer is a complication of diabetes mellitus which is the leading cause of lower limb amputations. It occurs in 15% of all patient with diabetes mellitus and precedes 84% of patients with diabetic foot ulcer which needs lower leg amputation. The management of diabetic foot ulcer requires blood sugar control, debridement, advanced dressing and offloading modalities. In Ayurvedic literature, Acharya Sushruta has described sixty treatment modalities, He has given more importance to Vranashodhana and Ropana. Acharya Vagbhatta has explained that Vranas which are caused by Madhumeha can be treated with Aragwadhadigana Dravyas, hence in the present study for Vrana Shodhanartha Prakshalana with Aragwadhadi Qwatha and Vrana Dhoopana by Guggulu, Nimba Choorna, Haridra, Jatyadi Ghrita were selected and for Vrana Ropanartha Jatyadi Taila was selected.

scholarly journals High density lipoprotein as prognostic indicator in patient with diabetic foot

2020 ◽  
Vol 8 (5) ◽  
pp. 1671
Author(s):  
Arie Rafael Singara ◽  
Chaeruddin Rasjad ◽  
Jufri Latief ◽  
Nasser Mustari ◽  
Arman Bausat
Keyword(s):  
High Density Lipoprotein ◽  
Diabetic Foot ◽  
Density Lipoprotein ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
High Density ◽  
Vascular Disorder ◽  
Cross Sectional ◽  
Significant Difference ◽  
Acting Agent

Background: Diabetic is a chronic metabolic disease with vascular disorder and HDL (High Density Lipoprotein) is a vascular protector acting agent. One of the most difficult complication of diabetics are diabetic foot with often lead to an amputation due to vascular disorder. Objective of this study aims to determine the relationship of HDL levels with diabetic foot severity by comparing HDL levels in each diabetic foot grade according to the Wagner classification.Methods: This is a cross sectional study, with new inpatient and outpatient with diabetic foot ulcer that never received therapy in Wahidin Sudirohusodo Hospital as a study population in April 2018 to June 2018 time period. Frequency distribution, Spearman’s Correlation, Anova, and Chi Square statistical analytic was done with p <0.05 considered as significant.Results: HDL level was wound highest in Grade I and lowest in Grade IV and V. HDL level comparison according to Wagner comparison shows significant difference, p<0.001.Conclusions: There were a negative correlation as an analysis results shows between HDL level and Wagner classification, whereas the lower HDL level, the higher diabetic foot grade and HDL can be used as a prognosis predictor and planning therapy.

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