References
Diabetic foot ulcers: evaluating the role of the specialist advanced practice nurse in complex chronic wounds
Abstract
Objectives:
To determine the profile of diabetes patients with neuropathic and neuro-ischaemic lesions who are referred to the advanced practice nurse (APN) in complex chronic wounds; to determine whether a training strategy aimed at primary care nurses and nursing homes that care for patients with diabetic foot disease influences the performance of professionals; and to assess the extent, follow-up and evaluation of diabetic foot disease in patients with neuropathic ulcers and neuro-ischaemic ulcers referred to the specialist APN before and after the training.
Methods:
The characteristics of patients referred to the APN over a period of 6.5 years were analysed, as well as the numbers of amputations and deaths pre- and post-training.
Results:
of the total of 103 patients, 78 were men; across both sexes the average age was 69 years. Fifty patients had neuropathic ulcers and 53 had neuro-ischaemic ulcers, with healing rates of 59%. There were 50 amputations and 37 deaths over the study period.
Conclusion:
Prevention of diabetic foot ulcers depends on having in place a fast, agile, practical clinical pathway between primary care and hospital, with the role of the APN, including the co-ordination of care between primary and secondary settings, being key.
Diabetic foot disease is a severe complication involving deep tissue lesions, and it is associated with current or previously diagnosed diabetes. Among the complications that may manifest are peripheral neuropathy, peripheral artery disease, infection, ulcer(s), neuro‑osteoarthropathy, gangrene and amputation. Foot ulceration is among the most serious complications of diabetes, which can lead to a reduced quality of life and incur financial costs for the person affected. Moreover, it places a considerable burden not only on the person's family, but also on health professionals and services, as well as society in general (Zhang et al, 2017; Fu et al, 2019; International Working Group on the Diabetic Foot (IWGDF), 2023). According to the IWGDF:
‘The vast majority of persons with a diabetes-related foot ulcer will have neuropathy. Peripheral artery disease (PAD), generally caused by atherosclerosis, is present in up to 50% of these patients and is an important risk factor for impaired wound healing, gangrene and lower-extremity amputation. A small percentage of foot ulcers in patients with severe PAD are purely ischaemic … the majority of foot ulcers, however, are either purely neuropathic or neuro-ischaemic ….’
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