Discuss about the Evidence Based Nursing Research for Diabetes Therapy.
Diabetic foot ulcers are the complications of the foot caused by Diabetes Mellitus and the foot is further referred to as Diabetic Foot. Since diabetes mellitus is a metabolic disorder, it impedes the process of wound healing and the complication exceeds. Management of diabetic foot ulcers is normally carried out by offloading the wound with the usage of right footwear, regular saline, debridement and antibiotic, controlling the blood glucose levels and rectification of the peripheral arterial insufficiency (Alexiadou & Doupis, 2012). This annotated bibliography will be reviewing and analyzing five peer-reviewed articles, which will be based on the research question designed by the author according to the PICO format. The research question for the annotated bibliography has been presented below.
‘Who are the affected population and what is the comparative intervention and outcome of the management of diabetic foot ulcer?’
To answer the research question, the author has carried out an annotated bibliography by selecting five peer-reviewed articles.
Diabetic foot ulcer is a complication arising out of diabetes and the patients suffering from the disease are the affected population. For investing the process of healing and development of diabetic foot ulcer among the patients with diabetes, the researchers carried out the present prospective cohort study. The sample size was 104 diabetic patients and the study duration was 18.4 ± 10.8 months. The evaluating factors for the study were serum inflammatory cytokines, vascular reactivity and growth factors. Statistical data analysis suggested that the ulcer was developed in 29% of the patients out of which, 53% of the patients healed and 47% did not heal during the study. From the study, it was found that the growth factors like MMP-9 and increased inflammatory cytokines levels are chiefly responsible for the development of the diabetic foot ulcers, along with the vascular and neuropathic factors. From the skin biopsy, it was revealed that the patients with diabetic foot ulcers had increased levels of immune cell infiltration when compared with the healthy individuals with higher WBC count and severe neuropathy. All these factors collectively contribute towards the occurrence of the ulcer and patients suffering from these abnormalities are the affected population. Targeting these factors in these patients can be effective in the management of diabetic foot ulcers.
The authors of this study compared the characteristics of healing of the diabetic foot ulcers that are treated with standard care and dehydrated human amniotic membrane allografts, also known as EpiFix. The authors conducted a prospective, comparative, parallel-group, randomized, stratified and non-blinded clinical trial for determining the wound care effectiveness of these two therapies. Patients were selected on a randomized basis and were classified into two groups of standard regimen and amniotic membrane group. For the evaluation of outcomes of the study, the patients were observed for a period of 12 weeks and their wound healing characteristics were evaluated. From the study, it was found that greater rates of healing were achieved with Epifix in comparison with the standard care procedure. The amniotic membrane served as a catalyst in the wound healing process. Neurotrophic diabetic foot ulcer was better managed with the EpiFix as 92% of the chronic cases were reported to be healed in comparison to 8% of the cases as with the standard method of care. From the study, it can be said that Epifix is an economically feasible and clinically viable option of treatment that can be effective for the management of diabetic foot ulcer. The authors have presented this novel method of treatment with a scientific approach that can be considered by the clinicians as a rapid and efficient option for the patients with diabetic foot ulcer.
Since there has been a gap identified by the authors in the management of diabetic foot ulcers, the authors carried out a systematic review that was the continuation of a previous research work by the same authors to identify the improvement in the healing process of the disease. 43 articles were selected from various academic databases like Medline and EMBASE, which were retrospective, and prospective controlled studies and the extracted data from the articles were summarized in the form of tables on a narrative basis. From the review, the authors found that among the recent therapies of diabetic foot ulcer, negative pressure wound therapy and hyperbaric oxygen therapy have been found to be most effective in the healing of diabetic foot ulcer. The authors have analyzed the literature based on the success and failure of the novel therapies and reached the conclusion with sufficient justification towards the found effectiveness of the therapy. From the 43 articles, it was clearly understood that a great deal of research had been conducted on this subject, however, the problem of the disease persists as effective therapies are limited in terms of standard care. Therefore, this attempt by the authors to find a suitable is truly commendable for the effective management of diabetic foot ulcer.
The authors carried out a mixed prospective cohort study to identify the factors that are related to the outcome of diabetic foot ulcers due to multidisciplinary treatment. For the study, 2,480 patients were selected who were suffering from diabetic foot ulcers. From the study, the authors identified the complexity factors that are strongly related to the outcome of primary healing of the disease. Diabetic foot ulcers were identified as the sign of the existing multi-organ disease that is underlying. The outcome parameters of the study included primary healing, minor amputation, major amputation and deceased unhealed. During the study, medical treatment was provided to the patients for optimizing the co-morbidity treatment and improving the metabolic control. Multiple regression analysis was carried out with the SPSS statistical software considering the factors of local characteristics, social factors, co-morbidity, clinical characteristics and demographic data. From the results, it was found that the rate of healing was found to be 90.6% without the occurrence of major amputations in the patients who survived. The authors thoroughly investigated the complexity factors that are contributory in the treatment of diabetic foot ulcers and prevent the amputation and death cases coming out of the disease. Therefore, it can be said that this research work can be beneficial in reducing the mortality and amputation rates due to diabetic foot ulcer and is focused on its better management.
The authors carried out a literature review to determine the management of diabetic foot ulcer and identify the means to reduce the severity of the disease for improving the quality of life. For conducting the review, the authors selected duration between 1980 and 2014 and searched for the peer-reviewed articles from five electronic databases with appropriate keywords. Various study designs were included in the study and the bibliographies were searched for identification of other studies. From the searched articles, the authors carried out an in-depth analysis to determine the effectiveness of each parameter identified various management parameters. The parameter for management included education, debridement, offloading, advanced dressing and surgery. The authors also studied few advanced therapies that included hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bioengineered skin and growth factors. All these parameters commonly aimed at the management of diabetic foot ulcer and the authors have conducted an extensive analysis with detailed representation of the results from various studies to demonstrate the extent of effectiveness of the individual parameters. From the various articles, the authors identified the severity and the management components for the rapid healing of diabetic foot ulcers for reducing the high morbidity and avoid the serious complications of the disease. Since diabetes happens to be prime reason of the disease, it frequently leads to the development of the ulcer and can cause lower limb amputation, unless appropriate intervention is provided to manage the complications and this issue has thoroughly researched in this article.
From the reviewed articles, it can be concluded that diabetic foot ulcer is one of the most serious consequences of diabetes as the condition of the patient is aggravated with the progression of the disease with significant socioeconomic impact. Effective management of the disease can result in healing of the disease, while 5-24% of the cases lead to lower limb amputation after remaining active for a considerable period. Therefore, the management of diabetic foot ulcer remains a therapeutic challenge that requires the reviewing of the treatments and strategies for achieving the goals without increasing the burden of treatment costs. This annotated bibliography has discussed and compared some of the novel approaches, while much has to be done for their appropriate implementation.
References
Alexiadou, K., & Doupis, J. (2012). Management of diabetic foot ulcers.Diabetes Therapy, 3(1), 1-15.
Apelqvist, J., Elgzyri, T., Larsson, J., Löndahl, M., Nyberg, P., & Thörne, J. (2011). Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. Journal of vascular surgery, 53(6), 1582-1588.
Dinh, T., Tecilazich, F., Kafanas, A., Doupis, J., Gnardellis, C., Leal, E., & Veves, A. (2012). Mechanisms involved in the development and healing of diabetic foot ulceration. Diabetes, 61(11), 2937-2947.
Game, F. L., Hinchliffe, R. J., Apelqvist, J., Armstrong, D. G., Bakker, K., Hartemann, A., & Jeffcoate, W. J. (2012). A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes/metabolism research and reviews, 28(S1), 119-141.
Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of diabetic foot ulcer. World J Diabetes, 6(1), 37-53.
Zelen, C. M., Serena, T. E., Denoziere, G., & Fetterolf, D. E. (2013). A prospective randomised comparative parallel study of amniotic membrane wound graft in the management of diabetic foot ulcers. International wound journal, 10(5), 502-507.
Dinh, T., Tecilazich, F., Kafanas, A., Doupis, J., Gnardellis, C., Leal, E., & Veves, A. (2012). Mechanisms involved in the development and healing of diabetic foot ulceration. Diabetes, 61(11), 2937-2947.Zelen, C. M., Serena, T. E., Denoziere, G., & Fetterolf, D. E. (2013).
A prospective randomized comparative parallel study of amniotic membrane wound graft in the management of diabetic foot ulcers. International wound journal, 10(5), 502-507.Apelqvist, J., Elgzyri, T., Larsson, J., Löndahl, M., Nyberg, P., & Thörne, J. (2011). Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients. Journal of vascular surgery, 53(6), 1582-1588.
Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of diabetic foot ulcer. World J Diabetes, 6(1), 37-53.
Game, F. L., Hinchliffe, R. J., Apelqvist, J., Armstrong, D. G., Bakker, K., Hartemann, A., & Jeffcoate, W. J. (2012). A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes.Diabetes/metabolism research and reviews, 28(S1), 119-141.
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