Wound care
Care for diabetic foot ulcers typically includes covering them with regenerative bandages.
It’s equally unsurprising, meanwhile, that researchers should have battled so hard for a more satisfying medical solution. Over recent years, there have been a number of advances here, including managing the blood glucose of at-risk individuals, and keeping wounds wrapped and moist. That’s a far cry from older ways of thinking – which wrongly led to ulcers being left uncovered. “Fortunately,” summarises Meloni, “a great improvement in knowledge and tools available for physicians has been achieved.”
Feet first Yet, speak to both Lázaro-Martínez and Meloni, and it’s clear that the most exciting development in fighting DFUs is the FTP. Lázaro-Martínez speaks for both experts when he describes this approach as “a simple tool” to ensure that everyone up and down a healthcare chain can recognise a DFU – then get vulnerable patients the care they need before surgeons ever need to wield the knife. This can essentially be understood as a question of timing: the faster a DFU is sorted, the less likely amputation becomes. Indeed, Meloni emphasises that many avoidable amputations, even in wealthy countries with robust health services, happen precisely because of delays.
But beyond the broad principle, how does the
FTP, jointly developed by the International Diabetic Foot Care Group and D-Foot International, actually work in practice? Probably the simplest explanation is that it’s a flowchart, colour-coded and with straightforward instructions for healthcare professionals to look out for. If, for instance, there are ‘signs of infection’, it means that the patient likely has a ‘complicated’ DFU. In this case, they should receive specialised attention within 72 hours. If, on the other hand, the wound already looks like it’s
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developing sepsis, the individual concerned should be hospitalised within just 24 hours. From there, the FTP offers a range of options for specific care hints, spanning everything from management in the community to surgery. The point, says Lázaro- Martínez, is that a DFU is referred from “primary care to the hospital” promptly and efficiently. Fortunately, there are signs that the FTP in all its simplicity can dramatically bolster medical outcomes. According to work by Meloni’s research team in Italy, for example, implementing an FTP led to a significant increase in the number of early referrals of DFU patients. The decline in late referrals – down to just 20.5% of cases from a peak of 60% – was just as dramatic. It goes without saying, Meloni adds, that this kind of shift can have significant consequences for doctors and patients alike. “The FTP,” he says, “may be a very useful tool for a global network between primary care and dedicated hospital to avoid delayed referral and identify severe DFUs early”. That hospitals, and indeed society at large, can also avoid the heavy expense that comes with amputations is a happy bonus too.
A multidisciplinary approach Of course, a procedure as comprehensive as an FTP can’t simply be implemented at will. On the contrary, liaising closely between primary doctors, DFU consultants, podiatrists and cardiovascular surgeons requires work, with both experts agreeing that a genuinely “multidisciplinary” stance is the key to success. As Meloni vividly puts it: “Diabetic [foot ulcers] is a multi-disease requiring a multi-specialist approach.” Certainly, this makes sense from a medical perspective. If, after all, a general practitioner isn’t trained to spot signs of sepsis in an infected foot, they’re hardly unlikely to refer a patient fast enough. Once they get to hospital, meanwhile, a nurse will need to diagnose them quickly – to say nothing of the attention patients will need once their crisis abates and they’re discharged home. Clearly, all this is a medical challenge of the first instance – and not only theoretically. In Italy, to give one example, Meloni explains that dermatologists are “rarely involved” in the fight against DFUs. For that to change obviously requires better training and stronger awareness. But more than that, you get the feeling that the biggest barrier to the wider implementation of FTPs might come in the form of sluggish administration. Lázaro-Martínez illustrates the problem well. “In some places,” he admits, “there isn’t a good relationship between different departments. In others, people have different perspectives of the same disease – and in the end it’s difficult to get people to set up a multidisciplinary team.” All the same, Lázaro-Martínez is convinced that the potential for awkward meetings and tension is worthwhile. Given how brutal DFUs can often be, it’s hard to disagree.
Practical Patient Care /
www.practical-patient-care.com
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